Table 3.

Commonly used inotropes and vasopressor drugs in neonatal shock.

Name of drug	Dose	Site of action	Hemodynamic effects
Dopamine	1–4 μg/kg/min	Dopaminergic receptors (1 and 2)	Renal and mesenteric dilatation
	4–10 μg/kg/min	α receptors	Inotropic effects
	11–20 μg/kg/min	β receptors	Vasopressor, increase SVR and increase PVR
Dobutamine	5–20 μg/kg/min	β1 and β2 receptors, some effect on α receptors	Inotropic effects; decrease SVR; increase cardiac output
Epinephrine (adrenaline)	0.02–0.3 μg/kg/min	α1 receptors	Inotropic effects; decrease SVR
	0.3–1 μg/kg/min	β1 and β2 receptors	Vasopressor effects; increase SVR
Nor-epinephrine (nor-adrenaline)	0.1–1 μg/kg/min	α1 and α2 receptors	Vasopressor effects; increase SVR
Hydrocortisone	1–2.5 mg/kg; 4–6 hourly	Enhance sensitivity to catecholamines	Uncertain—enhance sensitivity to catecholamines
Vasopressin	0.018–0.12 U/kg/h	Vasopressin 1 receptors	Increase SVR; no inotropic effect
Milrinone	50–75 μg/kg/min bolus followed by 0.25–0.75 μg/kg/min	Phosphodiesterase III inhibitor and produces effects at β1 and β2 receptors	Inodilator effects; lusitropic effects; increase contractility; and decrease SVR
Levosimendan	6–24 μg/kg/min bolus followed by 0.1–0.4 μg/kg/min	Multiple action including Phosphodiesterase inhibitor effect on higher doses	Inodilator effects; increase contractility without increasing myocardial oxygen demand

SVR, systemic vascular resistance; PVR, pulmonary vascular resistance.