Inotrope therapy for neonatal hypotension

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Low arterial blood pressure is a common adverse event in neonates, and is a feature of several clinical conditions specific to this population. Hypotension is associated with failure of adaptation to extrauterine life, perinatal asphyxia and patent ductus arteriosus. Additionally, cardiovascular instability with resulting fluctuations in blood pressure is commonly associated with preterm birth.

Treating hypotension and the resulting inadequate blood supply aims to ensure perfusion and oxygenation of tissues, and support cellular metabolism. This requires sustained cardiac output, which is determined by cardiac preload, afterload, myocardial contractility, and heart rate.

There is a lack of standardised guidelines for neonatal arterial hypotension, with questions relating to the most appropriate medication regime and which combination of drugs to use (Agakidou et al, 2024). Currently, there is a range of anti-hypotensive medications available for use with dopamine, dobutamine and adrenalin/epinephrine commonly adopted in clinical practice.