Neonatal Hypotension: What Is the Efficacy of Each Anti-Hypotensive Intervention? A Systematic Review

  • Felipe Y. Matsushita
  • Vera L. J. Krebs
  • Werther B. de CarvalhoEmail author
Pediatrics in South America (L Landry and WB de Carvalho, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Pediatrics in South America


Purpose of review

There is no consensus in the treatment of hemodynamic instability in the preterm newborn. Blood pressure is one of the few measurable objective parameters for hemodynamic evaluation in this population. However, little is known about the efficacy of anti-hypotensive treatments in newborns. The objective of this review is to identify and analyze the efficacy of a given anti-hypotensive intervention in improving the hypotensive preterm newborn.

Recent findings

With the increase in survival of the preterm newborns, there was an augmentation in the interest for the treatment of hypotension in this population. However, as there are doubts regarding the efficacy in anti-hypotensive treatment, new drugs are being used to reverse the hypotensive state in preterm infants: epinephrine, norepinephrine, vasopressin, and steroids.


We have identified that classically used medications in the treatment of hypotension have little evidence of efficacy in rescuing the preterm infant from the hypotensive state. New therapies are emerging with potential benefits, especially in refractory hypotension such as epinephrine and norepinephrine, but more prospective studies are needed. Literature review should be careful, considering the definition used for hypotension, the time of onset, the intravascular volume status of each patient, and if the drug was used as a first or second line of treatment.


Hypotension Premature Inotrope Volume resuscitation 


Compliance with Ethical Standards

Conflict of Interest

Felipe Y. Matsushita, Vera L. J. Krebs, and Werther B. de Carvalho declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Felipe Y. Matsushita
    • 1
  • Vera L. J. Krebs
    • 1
  • Werther B. de Carvalho
    • 1
    Email author
  1. 1.Department of Pediatrics, Neonatology Division, Faculty of Medicine of the University of São PauloInstituto da CriançaSão PauloBrazil

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