[Anuria after abdominal surgery in 2 newborn infants. Beneficial effect of noradrenaline]. / Anurie après chirurgie abdominale chez deux nouveau-nés. Effet bénéfique de la noradrénaline.

BACKGROUND: Abdominal surgery in neonates may be complicated by acute renal failure that is sometimes due to increased intra-abdominal pressure. Correction of the decreased renal perfusion may be difficult. CASE REPORTS: Case no 1. A girl weighing 3,000 g was operated on at 3 hours of life for congenital omphalocele. Closing the defect induced increased intra-abdominal pressure and decreased systemic pressure. Despite dopamine, dobutamine, followed by furosemide, anuria persisted without manifestations of heart failure. Noradrenaline (0.1 to 0.7 micrograms/kg/min intravenously) given 24 hours after surgery resulted in normalization of systemic pressure and diuresis. Case no 2. A boy was born at gestational week 30, weighing 1,450 g. At 8 days of age, he was suffering from shock that was attributed to perforation of the bowel due to necrotizing enterocolitis. Surgery was complicated by acute circulatory and renal failure that did not respond to dopamine, dobutamine or furosemide. Infusion of noradrenaline, (0.2 to 0.6 micrograms/kg/min intravenously) induced diuresis within 3 hours. CONCLUSIONS: Noradrenaline can be useful in patients with postoperative increased intra-abdominal pressure. It should only be given after correction of hypovolemia, control of myocardial function, and when dopamine remains ineffective.

Pharmacokinetics of midazolam during continuous infusion in critically ill neonates.

Midazolam is a water soluble benzodiazepine, with a short elimination half-life in adults and children. An IV bolus (0.2 mg.kg-1) immediately followed by continuous infusion of 0.06 mg.kg-1.h-1 was administered to 15 critically ill neonates at a gestational age of 32.8 weeks, who required sedation for mechanical ventilation. Heart rate and blood pressure were closely monitored. Hypotension occurred in 4 patients after the bolus dose or during the continuous infusion. Three of them had also been given fentanyl. Individual pharmacokinetic parameters were calculated: plasma clearance was 3.9 ml.min-1, elimination half-life was 12.0 h. Because of its short half-life compared to diazepam, midazolam may be used during the neonatal period to achieve rapid, brief sedation. However, it should be administered cautiously to neonates, particularly in premature infants, or if fentanyl is also given.