Challenges in the treatment of hypotension in an extremely preterm neonate

Abstract

Introduction Hypotension is often seen in preterm neonates, as a result of various factors such as immature myocardium, transitional circulation, perinatal hypoxia, positive-pressure ventilation, and relative adrenal insufficiency. The leading causes of hypotension in preterm neonates are sepsis and septic shock, patent ductus arteriosus (PDA), and necrotizing enterocolitis.

Case outline The female preterm neonate was delivered at 241/7 weeks of gestation with a birth weight of 710 g and an Apgar score of 3 in the first minute after birth. Hypotension was noted from the first day of life, so dopamine was administered. The neonate was admitted to the Institute of Neonatology on the fourth day of life and we continued dopamine and dobutamine. Despite increasing the dose, the hypotension remained persistent, and we started epinephrine. Echocardiography showed PDA and signs of heart failure. The neonate’s condition was complicated by acute renal injury. Therefore, ibuprofen was not used to close the PDA, so we continued its conservative treatment. In order to correct the hypotension, hydrocortisone was added to the therapy. Despite conservative treatment of the PDA, hypotension was persistent and severe, and its treatment lasted for four weeks of hospitalization. After achieving hemodynamic and respiratory stability, surgical ligation of the PDA was performed.

Conclusion Hypotension is a complication in the early neonatal period in an extremely preterm neonate. Knowing the cause, as well as the pathophysiology, allows for the selection of the appropriate drug and proper treatment of hypotension in preterm neonates, which is very challenging for neonatologists.

Keywords: premature newborn; ductus arteriosus; hypotension; cardiovascular agents