The most common drug used for treatment of systemic hypotension in premature and neonates are dopamine and dobutamine. For many years data on drug treatment have basically been extrapolated from adults to children. During the past decade new information on the biological differences in children and especially premature and sick neonates has provided a better understanding for drug treatment in infancy. However information regarding the side effects of the treatment of hypotension in neonates and premature infants is difficult to explore from literature. Hypotension in neonates is often associated with septicemia, which is a severe and potentially life threatening condition.
At Rikshospitalet University Hospital during the late 1990ies we registered an increasing number of severe cases with IVH and PVL in our NICU. We therefore evaluated our data on the treatment of the septic premature infant with hypotension. Several neonates with severe cerebral hemorrhages had been on treatment with dopamine and dobutamine shortly after birth. Some data showed a correlation between drug treatment and the onset of IVH and PVL compared to those children who were treated with fluid assessment before starting inotropes. This is similar to what is described in literature. Premature infants have less collateral and mainly end arteries that might contribute to an increased risk of cerebral hemorrhage on drug treatment with inotropes. We therefore believe that treating septic chock in children with aggressive volume resuscitation is not harmful as previously thought.
Regarding our experiences we hypothesize that for the reversal of shock, fluid resuscitation can be performed without causing a high incidence of IVH or PVL. This treatment contributes to maintain an adequate cerebral perfusion before starting drug treatment with inotropes. Therefore we are planning to do a retrospective study of our data from 1999-2003.
The NICU at Rikshospitalet University Hospital have approximately 800 admissions each year. Our NICU is a Center of Competence regarding the immature and sick neonates. Each year about 400 risk pregnancies are followed up here and these neonates are admitted to our NICU. We thereby have a unique possibility to perform such a study. The tools mainly used for this study will be The Neonatal program; a recently developed tool for collecting data on all neonates in Norway. This program provides data in order to assess outcome as well as doing epidemiologic studies.
The aim of the study is to show that a simple maneuver of septic chock of fluid recuscitation can be performed causing a decreased incidence of IVH/PVL in infants.
Material and Methods
The data from the Neonatal program as well as the patient records during the period from 1999 2003 will provide information on the different parameters. Data on drug treatment, fluid resuscitation, time of septic shock and time for replacement therapy, head circumference, hemodynamic parameters, PDA, UL sound of head, CT scan and MRI of cerebrum will be collected. MRI is one of the methods to assess neuroradiologic sequele discriebed in the literature .
The incidence of IVH/PVL will be compared between the age-matched premature and term babies treated with 40 ml/kg or greater amount of fluid or without inotropes and those treated with less than 20 ml/kg fluid with or without inotropes.
The descriebed protocol will have the advantage of contributing new knowledge into the area of intensiv treatment of neonates. These results might have an impact on shock treatment of older children as well. The knowledge aquired will be of benefit to sick infants everywhere and will be avaiable to physicians treating sick neonates. Our results will be published in International Medical Journals as well as National Journals and Meetings.