The Effect of Maternal Antihypertensive Drugs on the Cerebral, Renal and Splanchnic Tissue Oxygen Extraction of Preterm Neonates
Anne E Richter1, Trijntje E Schat, Koenraad N J A Van Braeckel, Sicco A Scherjon, Arend F Bos, Elisabeth M W Kooi
Drugs with antihypertensive action, such as labetalol and nifedipine, are commonly used in obstetrics to treat preeclampsia. However, they may impact the hemodynamics of preterm neonates. This study examines how maternal antihypertensive drugs influence oxygen extraction in the brain (cerebral), kidneys (renal), and intestines (splanchnic) of preterm neonates (born ≤32 weeks gestation) using near-infrared spectroscopy, where researchers monitored oxygen levels during the first five days of life.
This study is the first to evaluate the effects of maternal antihypertensive drugs on multisite tissue oxygen extraction. It found that exposure to these drugs, particularly labetalol, was associated with significantly lower cerebral oxygen extraction (cFTOE) and higher splanchnic oxygen extraction (sFTOE) compared to nonexposed neonates. These findings suggest that labetalol may increase brain blood flow through vasodilation or reduce oxygen use in the brain. The elevated splanchnic oxygen extraction (sFTOE) likely reflects reduced intestinal blood flow, as the intestines are less protected by autoregulatory mechanisms.
These results underline the importance of monitoring cerebral and abdominal oxygenation in preterm neonates during their early days of life to mitigate potential risks. They also point to the effects of maternal medications from underlying maternal conditions, such as preeclampsia, which may independently influence neonatal oxygenation patterns. Understanding these mechanisms can guide more precise monitoring and management strategies for hypertension during pregnancy and improving neonatal outcomes.
References:
Richter, A. E., Schat, T. E., Van Braeckel, K. N., Scherjon, S. A., Bos, A. F., & Kooi, E. M. (2016). The Effect of Maternal Antihypertensive Drugs on the Cerebral, Renal and Splanchnic Tissue Oxygen Extraction of Preterm Neonates. Neonatology, 110(3), 163–171. https://doi.org/10.1159/000445283
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