Cardiovascular, renal, and endocrine actions of dopamine in neonates and children,☆☆,,★★

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PHYSIOLOGY OF THE CNS AND PERIPHERAL DOPAMINERGIC SYSTEM

Dopamine, in addition to being a precursor of norepinephrine and epinephrine, is a naturally occurring endogenous catecholamine. In the CNS, dopaminergic modulation of ion fluxes regulate emotion, activity, behavior, and nerve conduction. In the CNS and peripheral adrenergic system, and in certain endocrine organs, dopamine also regulates the release of other hormones, including prolactin,9, 10 thyrotropin,9, 10 growth hormone,11 gonadotropins,9 antidiuretic hormone,12 renin,13, 14 and

STRUCTURE, DISTRIBUTION, POSTRECEPTOR MECHANISMS, AND FUNCTION OF THE PERIPHERAL DOPAMINE RECEPTORS

Dopamine receptors belong to a large family of seven transmembrane domain-containing G-protein-coupled cell surface hormone receptors.20 On the basis of pharmacologic criteria, two subtypes of both the CNS and peripheral dopamine receptors have been identified and are designated as D1 and D2, and as DA1 and DA2, respectively.16, 17, 20, 21Peripheral dopamine receptors are dopamine receptors present outside the CNS in the cardiovascular system,17 adrenergic nerve endings,22 renal tubules,21 and

CARDIOVASCULAR, RENAL, AND ENDOCRINE ACTIONS OF DOPAMINE

Irrespective of the cause of the cardiovascular collapse, dopamine has been widely used in the treatment of shock in children8 and in term2, 7 and preterm neonates.1, 2, 3, 4, 5, 6 Exogenous dopamine exerts its complex effects almost exclusively by the dose-dependent stimulation of the dopaminergic, the α-and β-adrenergic and the serotonin receptors.3, 16, 17, 38, 39 The ability of dopamine also to stimulate other aminergic receptors appears to be related to the flexibility of the side chain

CONCLUSIONS

This review has summarized the recent discoveries of the cellular and molecular mechanisms of the dopaminergic effects in the developing and mature cardiovascular system, kidney, and certain endocrine organs. These insights have direct clinical applications; the thoughtful clinician will apply this knowledge accordingly and consider the many potential effects of dopamine when using the drug and evaluating the efficacy of therapy.

I thank Drs. Roberta R. Ballard and Judy C. Bernbaum for their

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    From the Division of Neonatology, Department of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania

    ☆☆

    Reprint requests: Istvan Seri, MD, PhD, Division of Neonatology, Department of Medicine, Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA 19104.

    The Journal of Pediatrics 1995;126:333-44

    ★★

    0022-3476/95/$3.00 + 0 9/18/61903

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