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Anti-hypotensive treatment, which includes dopamine, dobutamine, epinephrine, norepinephrine, milrinone, vasopressin, terlipressin, levosimendan, and glucocorticoids, is a long-established intervention in neonates with arterial hypotension (AH). However, there are still gaps in knowledge and issues that need clarification. The main questions and challenges that neonatologists face relate to the reference ranges of arterial blood pressure in presumably healthy neonates in relation to gestational and postnatal age; the arterial blood pressure level that potentially affects perfusion of critical organs; the incorporation of targeted echocardiography and near-infrared spectroscopy for assessing heart function and cerebral perfusion in clinical practice; the indication, timing, and choice of medication for each individual patient; the limited randomized clinical trials in neonates with sometimes conflicting results; and the sparse data regarding the potential effect of early hypotension or anti-hypotensive medications on long-term neurodevelopment. In this review, after a short review of AH definitions used in neonates and existing data on pathophysiology of AH, we discuss currently available data on pharmacokinetic and hemodynamic effects, as well as the effectiveness and safety of anti-hypotensive medications in neonates. In addition, data on the comparisons between anti-hypotensive medications and current suggestions for the main indications of each medication are discussed. [ABSTRACT FROM AUTHOR]

Background: BP monitoring is mandatory in all newborns to find out the cardiac as well as renal diseases. Premature infants have a limited ability to auto regulate cerebral blood flow when compared to full-term infants and hypotension is a major concern in them. Measures should be taken to detect neonatal hypotension and hypertension as earlier as possible and thereby they can be managed well. Aim: To determine the normative distribution of blood pressure in healthy newborns in the tertiary care setting in 1st 48 hours of life. To find out the factors affecting blood pressure in healthy newborn and to find out relationship between blood pressure distribution and anthropometric measurements of neonates. Materials and Methods Study design: This is a descriptive cross sectional study was conducted in the post-natal ward of DR.SMCSI Medical College Hospital, Karakonam, Kerala, India. Study population: Newborns in the postnatal ward after physical examination including modified Ballard assessment and APGAR score at 1 and 5 minutes were selected for the study. Study size: Study consisted of 400 Newborn. Study tools and Data collection procedure: Blood pressure measurements were taken at age 0–24 hours and 25-48 hours, three times at five minutes interval to get average values. BP measurement was performed with the neonate in the supine position, either awake or quiet or during sleep. The newborn was left for 10-15 min after the application of appropriate size cuff to the right arm to ensure quietness [12] . The automatic cuff inflation and deflation by the instrument rendered display of the BP values (systolic, diastolic and MAP) on the screen. Values are disregarded if any movement occurred during the measurement. The entire procedure was repeated twice as a standardization procedure for deriving on a single valid measurement. Weights of infants were measured by placing the baby naked on an infant’s weighing scale and length of the newborn was measured using an Infantometer. Results: The mean SBP, DBP and MAP for term babies in the first 24 hours of life were 70.7±14 mmHg, 39.1±11 mmHg and 49.6±11 mmHg respectively. For preterm, the corresponding values were 70.1±21 mmHg, 36.5±12 mmHg and 47.7±13.8 mmHg respectively. A significant positive correlation (p value<0.05) was observed between heart rate and blood pressure values of newborns both at 0-24 and 25- 48 hours of life. Conclusion: The normative distribution of mean arterial pressure in the term neonates in the first 48 hours of life was 49±9 mmHg. The normative distribution of mean arterial pressure in the preterm neonates in the first 48 hours of life was 47±13 mmHg. All three parameters (SBP, DBP, and MAP) were lower in preterm neonates compared to term neonates. DBP and MAP values significantly rose with increase in the birth weight of neonates at 0- 24 hours. Blood pressure values of neonates are also influenced by gestational diabetes mellitus and use of antenatal steroid. Maternal age and maternal BMI were found to have a significant influence in the blood pressure values of their babies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effect of low dose vasopressin on the hemodynamics of neonates with persistent pulmonary hypertension and catecholamine refractory shock. Methods: This retrospective study was conducted in a level III NICU of a tertiary care teaching hospital, south India. Eighteen neonates with hypoxemic respiratory failure due to persistent pulmonary hypertension of newborn with catecholamine refractory shock were studied. Neonates were managed for hypotension with conventional inotropic support with the additional use of low dose vasopressin (LDV). Effect of vasopressin on oxygenation index (OI), blood pressure, duration of inotropic usage and survival was evaluated. Results: Mean OI was 38.2 ± 4.9, and mean blood pressure was 30.7 ± 5.3 mmHg before the start of vasopressin. Initiation of LDV (0.0003 ± 0.0001 IU/kg/min) for a median duration 36.4 ± 17.9 h was followed by a reduction in OI (p < 0.001), control of hypotension (p < 0.001), reduction in lactic acidosis (p < 0.001) and decline in inotropic support. Conclusions: In resource-restricted settings, LDV may be useful as a rescue therapy for persistent pulmonary hypertension of newborn with catecholamine refractory shock. [ABSTRACT FROM AUTHOR]

This article is about a national survey looking at the policies for management of neonatal hypotension across the neonatal units in the UK. The survey shows a wide variation across the country in the management practice for neonatal hypotension and highlights the need for national guidelines. [ABSTRACT FROM AUTHOR]