Hypotension neonatal

The calcium channel blockers have been associated with both prolonged pregnancy and decreased neonatal morbidity.36,42 when compared with P-mimetics (e.g., terbutaline) and magnesium, they show better neonatal outcome and a lower incidence of serious maternal side effects.42 Potential minor maternal adverse effects include headache, flushing, dizziness, and transient hypotension.41... 

Alprostadil JProstaglandin E ] (Prostin VR) [Vasodilator/ Prostaglandin] WARNING Apnea in up to 12% of neonates esp <2 kg at birth Uses Conditions ductus arteriosus blood flow must be maintained sustain puhn/systemic circulation until OR (eg, pulm atresia/stenosis and transposition) Action Vasodilator (ductus arteriosus very sensitive), pit inhibitor Dose 0.05 mcg/kg/min IV to lowest that maintains response Caution [X, -] Contra Neonatal resp distress synd Disp Inj meg SE Cutaneous vasodilation, Sz like activity, jitteriness, T temp, thrombocytopenia, BP may cause apnea Interactions T Effects OF anticoagulants antihypertensives, effects OF cyclosporine EMS Given to newborns in hospital OD May cause apnea, bradycardia, hypotension, and flushing symptomatic and supportive... 

MAC values for a particular volatile anaesthetic are highest in neonates and lowest in the elderly although the explanation for this is not clear. MAC values are unaffected by gender, duration of exposure, and acid-base status. MAC is reduced by induced hypotension, hypothermia and hypoxia. Drugs... 

Investigators from the Department of Pediatrics in Johns Hopkins Hospital, after seeing a neonate who had marked leukocytosis temporally related to alprostadil, conducted a retrospective study of neonatal leukocytosis induced by alprostadil in 45 neonates (5). They concluded that alprostadil infusion is a predictable cause of leukocytosis in neonates with congenital heart disease. Alprostadil-induced leukocytosis was especially prominent in three patients with splenic disorders associated with the hetero-taxy syndrome. Many of the other adverse effects of alprostadil, including respiratory depression, hypotension, fever, and lethargy, were also associated with sepsis. The authors considered that it is reasonable to look for sepsis in infants receiving alprostadil, but that it is equally reasonable to withdraw empirical therapy once infection has been ruled out. Leukocytosis associated with alprostadil infusion has not been previously reported and is not listed in the alprostadil package insert. 

The safety of benzodiazepines in neonates has been assessed in a retrospective chart review of 63 infants who received benzodiazepines (lorazepam and/or midazolam) as sedatives or anticonvulsants (57). Five infants had hypotension and three had respiratory depression. In all cases of respiratory depression, ventilatory support was initiated or increased. Significant hypotension was treated with positive inotropic drugs in two cases. Thus, respiratory depression and hypotension are relatively common when benzodiazepines are prescribed in these patients. However, both depression and hypotension could also have been due to the severe underlying illnesses and concomitant medications. Matched controls were not studied. 

Several adverse effects have been reported with the combined use of fentanyl and midazolam, including chest wall rigidity, making ventilation with a bag and mask impossible (SEDA-16, 79). In neonates, hypotension can occur (SEDA-16, 80), and respiratory arrest in a child and sudden cardiac arrest have been reported (SEDA-16, 80). However, in one study there were no cardiac electrophy-siological effects of midazolam combined with fentanyl in subjects undergoing cardiac electrophysiological studies (SEDA-18, 80). 

Hypotension has occurred in neonates given midazolam and fentanyl... 

Hypotension follows the intravenous injection of benzodiazepines, but is usually mild and transient (SED-11, 92) (56), except in neonates who are particularly sensitive to this effect (57). Local reactions to injected diazepam are quite common and can progress to compartment syndrome (SEDA-17, 44). In one study (58), two-thirds of the patients had some problem, and most eventually progressed to thrombophlebitis. Flunitrazepam is similar to diazepam in this regard... 

A single intravenous dose of labetalol 30 mg given to a woman with severe pregnancy-related hypertension 20 minutes before cesarean section was associated with significant neonatal beta-adrenoceptor blockade (hypoglycemia, bradycardia, and hypotension), and there were high labetalol concentrations in the umbilical cord blood (150-180 ng/ml) (13). 

In 60 women who underwent elective cesarean section under epidural anesthesia, 0.5% levobupivacaine or 0.5% bupivacaine (30 ml) were equally efficacious in terms of anesthesia (115). The incidence and severity of motor blockade, hypotension, changes in QT interval, nausea, and vomiting were not significantly different, and neither were the neonatal Apgar scores. 

Maternal hypotension and excessive placental transfer of local anesthetics and other drugs, for example narcotics or sedatives, given to the mother before or during delivery are the main causes of neonatal death related to the use of these agents in obstetrics. However, deaths are very infrequent (155). 

When an opioid is used as the sole agent by the epidural or intrathecal route, the results are disappointing, because of unwanted adverse effects, such as pruritus, nausea, vomiting, respiratory depression, and effects on the neonate, caused by significant systemic absorption (SEDA-17, 85). Hypotension and changes in fetal heart rate are not uncommon (SEDA-21, 91). Combinations of opioids (alfentanil, fentanyl, morphine, sufentanil) with local anesthetics (for example bupivacaine) have therefore been suggested to yield better results (SEDA-18, 83). 

Based upon the available evidence it is advised not to use ACEI during pregnancy. In the case of an ACEI-exposed fetus, the pediatrician should be notified of the potential for neonatal hypotension and anuria. 

Smith J E, Dever M, Smith J et al 1992 Post-transfusion survival of Cr-labeled erythrocytes in neonatal foals. Journal of Veterinary Internal Medicine 6 183-185 So K W, Fok T F, Ng P C et al 1997 Randomised controlled trial of colloid or crystalloid in hypotensive preterm infants. Archive of Diseases in Childhood 76 F43-F46 Sosa Ledn L A, Davie A J, Hodgson 0 R et al 1995 The effects of tonicity, glucose concentration and temperature of an oral rehydration solution on its absorption and elimination. Equine Veterinary Journal Supplement 20 140-146... 

Although it is always difficult to prove that a certain drug or drug class induces fetal toxicify, fhe reports on ACEI-induced fetal renal damage are substantial. The most commonly reported fetal side effect of ACEI is second to thbd trimester onset of ohgohydram-nios and growth restriction, followed by delivery of an infant whose neonatal course is complicated by prolonged and often profound hypotension and anuria... 

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