Physiology-guided vasoactive therapy in neonates: rethinking dopamine as first-line.

Dopamine has been widely used as a first-line cardiovascular agent in neonatal intensive care units (NICUs) for the management of hypotension and circulatory support. While its effectiveness in increasing blood pressure is established, its potential effects on pulmonary vascular resistance, myocardial function, and overall hemodynamics require further consideration. This review explores the role of dopamine in neonatal hemodynamic management and considers alternative vasoactive agents tailored to specific pathophysiological conditions. A more individualized, physiology-based approach to cardiovascular support in neonates may help optimize treatment strategies.