Questions and controversies in the management of hypotension in preterm infants

Hypotension is a frequent condition that affects preterm infants during the first days of life, within the transition period to an extrauterine environment, or associated with neonatal pathology. Persistent hypotension in the neonatal period is associated with increased neonatal morbidity and mortality. Understanding neonatal hemodynamics is the first step in approaching hypotensive neonatal patients. Treating hypotension should aim to restore impaired blood flow and maintain cellular metabolism. Neonatologists should look beyond values of blood pressure and check for markers of low systemic blood flow and inadequate organ perfusion. There are many anti-hypotensive agents, but choosing the most appropriate intervention should take into consideration the underlying pathophysiologic process, the effectiveness versus side effects of the drug, and medium- and long-term developmental outcomes. This article intends to review the therapeutic options for neonatal hypotension to offer clinicians support for an evidence-based choice.