Table 2.
Commonly used pharmacological agents for haemodynamic support in persistent pulmonary hypertension of the newborn.
| Drug with dose | Remarks | |
|---|---|---|
| 1 | Dopamine | Can improve cardiac output. But doses > 10 μg/Kg/min can increase PVR |
| (a) Moderate dose 3–5 μg/Kg/min | ||
| (b) High dose 6–30 μg/Kg/min | ||
| 2 | Dobutamine | Has inotropic effect more than chronotropic effect |
| Same dose as dopamine | ||
| 3 | Epinephrine | Should be given cautiously as it can increase PVR |
| 0.03–0.1 μg/Kg/min | ||
| 4 | Milrinone | Add milrinone in place of dobutamine if BP is within the acceptable range, as milrinone is a pulmonary vasodilator11 |
| (a) Loading dose 50 μg/Kg | ||
| (b) Maintenance dose 0.25–0.5 μg/Kg/min | ||
| 5 | Hydrocortisone | In very sick neonates with hypotension refractory to catecholamine administration. |
| 1 mg/Kg (can be repeated 12 hourly for 2–3 days) | Hydrocortisone rapidly upregulates cardiovascular adrenergic receptor expression and serves as a hormone substitute in cases of adrenal insufficiency1 |
PPHN: persistent pulmonary hypertension of the newborn, PVR: pulmonary vascular resistance.