Journal of Clinical Neonatology

LETTER TO EDITOR
Year
: 2015  |  Volume : 4  |  Issue : 1  |  Page : 66--67

Vasomotor instability in a preterm neonate causing hypotension and acrocyanosis - Exaggerationof a normal physiological phenomena?


Pankaj Kumar Mohanty1, Abdul Razak2, N Karthik Nagesh3,  
1 MD Pediatrics, Fellow in DNB Neonatology, Manipal Hospital, Bangalore, Karnataka, India
2 MD Pediatrics, MRCPCH, Fellowship In Neonatology (IAP), Associate consultant Department of Neonatology, Manipal Hospital, Bangalore, India
3 MD Pediatrics, FRCPCH, Fellowship In Neonatology (UK), Professor and HOD Department of Neonatology, Manipal Hospital, Bangalore, India

Correspondence Address:
Pankaj Kumar Mohanty
Pursuing DNB Neonatology Manipal Hospital, Bangalore - 560 017, Karnataka
India




How to cite this article:
Mohanty PK, Razak A, Nagesh N K. Vasomotor instability in a preterm neonate causing hypotension and acrocyanosis - Exaggerationof a normal physiological phenomena?.J Clin Neonatol 2015;4:66-67


How to cite this URL:
Mohanty PK, Razak A, Nagesh N K. Vasomotor instability in a preterm neonate causing hypotension and acrocyanosis - Exaggerationof a normal physiological phenomena?. J Clin Neonatol [serial online] 2015 [cited 2020 Nov 25 ];4:66-67
Available from: https://www.jcnonweb.com/text.asp?2015/4/1/66/151179


Full Text

Sir,

Preterm babies are subjected to many stresses after being born. Out of many complications that a preterm suffers, vasomotor instability is a significant one, which is observed in few early and late preterms. The infant usually develops acrocyanosis, temperature instability, hypotension, and sepsis-like features. [1]

We came across a newborn preterm, born to a G2A1 mother, at 34 weeks gestation, by emergency lower segment Cesarean section (LSCS) (in view of severe pre-eclampsia). The baby cried after birth. The birth weight was 1.36 kg. The APGAR scores at one and five minutes were 8 and 9, respectively. The mother had received two doses of antenatal steroids, and the antenatal scans including Doppler's were normal and had no risk factors for sepsis. The baby after being born was stable in room air and did not require any form of respiratory support. The baby was hemodynamically stable and was maintaining normal oxygenation and saturation in room air. The infant was eumorphic and euglycemic. Trophic feeds were introduced on day one. The baby also received total parenteral nutrition through a peripherally inserted central line. At 18 hours of life, the baby was seen to have acrocyanosis in the bilateral upper and lower limbs. The peripheral and core temperature difference was more than 3°C. The baby also developed hypotension and metabolic acidosis. Early onset sepsis was suspected so septic screen was done, which was negative. Screening echocardiography and ultrasonography (USG) of the cranium were normal. Serum electrolytes, Serum, Calcium (Ca), and Magnesium (Mg) were normal as well.

The possibility of vasomotor instability was considered. Low-dose dopamine was started and appropriate fluid management was done. The baby improved over the next 12 hours, the blood pressure normalized, the acrocyanosis disappeared, and finally the peripheral temperature difference also came down. The baby tolerated full feeds and never had such an episode again

Vasomotor instability occurs in extreme preterm, but it can occur in the late preterm population also. It generally mimics early onset sepsis (EOS) and causes hemodynamic instability. It is generally unrecognized in such preterms, as they are attributable to sepsis and a majority of them receive antibiotics and improve on their own. Vasomotor instability should be suspected in preterms having the above-mentioned features, who are clinically well, but develop signs of hemodynamic instability such as acrocyanosis, hypotension, and temperature instability. [2],[3] Only fluid, temperature management, and sometimes inotropes are all that are required. This entity should be kept in mind by the treating neonatologist and one should not be in a hurry to do too many investigations, which are of little use.

References

1Mok Q, Bass C, Ducker D, McIntosh N. Temperature instability during nursing procedures in preterm neonates. Arch Dis Child 1991;66:783-6.
2Knobel R, Holditch-Davis D. Themoregulation and heat loss prevention after birth and during neonatal intensive-care unit stabilization of extremely-low-birth weight infants. J Obstet Gynecol Neonatal Nurs 2007;36:280-7.
3Buetow K, Klein S. Effect of maintenance of 'normal' skin temperature on survival of infants of low birth weight. Pediatrics 1964;34:163-70.