Original ArticleHypotension following Patent Ductus Arteriosus Ligation: The Role of Adrenal Hormones
Section snippets
Methods
Between May 2009 and February 2012, 95 infants were enrolled at 12 sites with institutional review board approval and parental consent. Infants were eligible for the study if they were: (1) delivered between 231/7 and 316/7 weeks' gestation; and (2) scheduled for PDA ligation. The criteria to determine the need for ligation were not standardized between the centers. The decision to perform the ligation was made by the clinical care teams. Infants were excluded from the trial if they had: (1)
Results
Ninety-five infants were enrolled in the study before PDA ligation; 52 infants were normotensive throughout the postoperative period, and 43 infants developed hypotension: 14 infants had minimal hypotension (ie, were treated with volume boluses alone [18 ± 6 mL/kg]); 29 also received catecholamines (dopamine-alone, 72%; dobutamine-alone, 7%; dopamine and dobutamine, 21%). Six infants had mild, 9 moderate, and 14 severe/catecholamine-resistant hypotension. Twelve of the 14 infants with
Discussion
We hypothesized that an immature or impaired adrenal response to stress (with low levels of cortisol and high levels of cortisol precursors) might be responsible for the postoperative hypotension that often follows PDA ligation. Our findings do not support this hypothesis. In fact cortisol concentrations in infants who developed postoperative hypotension (responsive to catecholamine or volume resuscitation) were significantly greater than cortisol concentrations measured in normotensive infants
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Supported by the Thrasher Research Fund, National Institutes of Health National Heart, Lung, and Blood Institute (HL109199), and National Center for Research Resources (CTSI UL 1 TR000004 through the University of California, San Francisco), and the Jamie and Bobby Gates Foundation. Mass spectrometry was supported by the Michigan Nutrition Obesity Center (DK089503) and Michigan Regional Comprehensive Metabolomics Research Core (U24DK097153). The authors declare no conflicts of interest.
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A list of members of the PDA Ligation/Hypotension Trial Investigators is available at www.jpeds.com (Appendix).