TY - JOUR ID - 2009 TI - Comparison of High and Low Doses of Captopril in the Treatment of Neonates with Left-to-Right Shunt JO - Iranian Journal of Neonatology JA - IJN LA - en SN - 2251-7510 AU - Amoozgar, Hamid AU - Naghshzan, Amir AU - Alinejad, Saeed AU - Pishva, Narjes AU - Ahmadipoor, Maryam AU - Shakiba, Ali Mohammad AU - Edraki, Mohammad Reza AD - Neonatology Research Center, Department of Pediatrics, Namazi Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Y1 - 2014 PY - 2014 VL - 4 IS - 4 SP - 22 EP - 27 KW - Angiotensin-converting enzyme inhibitors KW - congenital heart disease KW - heart failure KW - Left-to-right shunt KW - Neurohormones DO - 10.22038/ijn.2013.2009 N2 - Introduction: Due to the significant differences between the physiology and pathology of adults and neonates, clinical guidelines for adults are not directly applicable to children. This study was performed to evaluate the effects of high- and low- dose captopril on the neonates with large left-to-right shunts. Methods: The study was conducted on 20 neonates with congenital heart disease, left-to-right shunt, and cardiac failure. Based on the Ross scoring system, the neonates were clinically evaluated by measuring renin, aldosterone, and B-type natriuretic peptide, and performing echocardiography. For each neonate, the treatment of heart failure started with digoxin and frusemide, and reevaluation was conducted 3 days after the treatment. Afterwards, the neonates were randomly divided into 2 groups; low- (0.03mg/kg) and high-doses (0.5mg/kg) of captopril were administered, and the reevaluation was carried out, after one week of therapy. Results: The study revealed higher reduction of the Ross score in the high-dose group; however, the change was not statistically significant (P=0.56). B-type natriuretic peptide and aldosterone reduced further in the high-dose group; again the changes were not statistically significant (P=0.4). Moreover, the treatment with captopril increased the pulmonary blood flow (QP), and pulmonary-to-systemic blood flow (QP/QS) in both groups; though the changes were not significant. Conclusion: According to the present study, although high-dose captopril can decrease B-type natriuretic peptide and the neonates' clinical symptoms, the resultant changes are not statistically significant. Therefore, clinical decision making should follow a case-by-case basis for each neonate, in order to select the effective dose of captopril. UR - https://ijn.mums.ac.ir/article_2009.html L1 - https://ijn.mums.ac.ir/article_2009_e2c6b744f39426c0f94e5a091edeea85.pdf ER -