Challenges in the treatment of hypotension in an extremely preterm neonate

Introduction. Hypotension is often in preterm neonates, as a result of various factors such as immature myocardium, transitional circulation, perinatal hypoxia, positive pressure ventilation and relative adrenal insufficiency. The leading causes of hypotension in preterm neonates are sepsis and septic shock, patent ductus arteriosus and necrotizing enterocolitis. Case outline. The female preterm neonate delivered at 241/7 weeks of gestation with birth weight of 710 g and Apgar score of 3 in first minute after birth. The hypotension was registered from the first day of life, so dopamine was administered. The neonate was admitted to Institute of Neonatology on the fourth day of life and we continued dopamine and dobutamine. Despite increasing the dose, the hypotension was still persistent and we started epinephrine. Echocardiography showed patent ductus arteriosus and signs of heart failure. The neonate?s condition was complicated by acute renal injury. Therefore, ibuprofen was not used to close the patent ductus arterisus, so we continued its conservative treatment. In order to correct the hypotension, hydrocortisone was added to the therapy. Despite conservative treatment of the patent ductus arteriosus, hypotension was persistent and severe, and its treatment lasted for four weeks of hospitalization. After achieving hemodynamic and respiratory stability, surgical ligation of the patent ductus arteriosus was performed. Conclusion. Hypotension is a complication in early neo-natal period in extremely preterm neonate. Knowing the cause, as well as the pathophysiology, allows the selection of the appropriate drug and proper treatment of hypotension in preterm neonates, which is very challenging for neonatologists.