Objective: To describe the clinical course of a newborn (gestational age 38 wk, 6 d) administered intravenous nicardipine to control hypertension while on extracorporeal membrane oxygen (ECMO) support.
Setting: Urban, university teaching hospital.
Case summary: A 1-day-old male neonate presenting with a left congenital diaphragmatic hernia developed a sustained elevation in blood pressure following a change of ECMO tubing. After several unsuccessful treatment regimens, nicardipine was started at a rate of 0.5 micro g/kg/min and aggressively titrated to 1.5 micro g/kg/min. Nicardipine produced a sustained antihypertensive effect that was noticed 8 hours after the start of the infusion. The infusion was continued through postoperative day 2. Following a second circuit change, nicardipine was discontinued and sodium nitroprusside therapy was started. Treatment with nitroprusside failed to lower the blood pressure.
Discussion: Nicardipine is an effective antihypertensive agent for neonates receiving ECMO therapy. However, the expanded volume of distribution caused by the ECMO circuit may result in a reduced serum concentration and a reduced antihypertensive effect.
Conclusions: We recommend a conservative initial dose of nicardipine of 0.5 micro g/kg/min that is aggressively titrated to reduce blood pressure effectively in neonates receiving ECMO therapy.