Randomized, blind trial of dopamine versus dobutamine for treatment of hypotension in preterm infants with respiratory distress syndrome

• Published in: The Journal of pediatrics Vol. 125; no. 1; pp. 117 - 122
• Main Authors: Klarr, Judith M., Faix, Roger G., Pryce, Cynthia J.E., Bhatt-Mehta, Varsha
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.07.1994; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Dobutamine - therapeutic use; Dopamine - therapeutic use; Double-Blind Method; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Humans; Hypotension - complications; Hypotension - drug therapy; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases - drug therapy; Intensive care medicine; Medical sciences; Prospective Studies; Respiratory Distress Syndrome, Newborn - complications; Treatment Outcome; RDS; MAP; IVH; Human; Premature; Dopamine; Respiratory disease; Treatment efficiency; Cardiovascular disease; Chemotherapy; Newborn; Treatment; Arterial hypotension; Respiratory distress; Arterial pressure; Blood pressure; Comparative study; Beta blocking agent
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(94)70137-7

To compare the efficacy of dopamine and dobutamine for the treatment of hypotension (mean arterial blood pressure, ≤30 mm Hg) in preterm (≤34 weeks of gestation) infants with respiratory distress syndrome in the first 24 hours of life, we enrolled 63 hypotensive preterm infants in a randomized, blind trial. Inclusion criteria required an arterial catheter for measurement of mean arterial blood pressure, treatment with exogenous surfactant, and persistent hypotension after volume expansion with 20 ml/kg (packed erythrocytes if hematocrit <0.40, 5% albumin if ≥0.40). Intravenous study drug infusions were initiated at 5 μg/kg per minute and then increased in increments of 5 μg/kg per minute at 20-minute intervals until a mean arterial blood pressure >30 mm Hg was attained and sustained for ≥30 minutes (success) or a maximum rate of 20 μg/kg per minute was reached without resolution of hypotension (failure). The study groups at entry were comparable for birth weight, gestational age, postnatal age, gender, birth depression, hematocrit <0.40, heart rate, oxygenation index, delivery route, maternal chorioamnionitis, and maternal magnesium or ritodrine therapy. No infants in the dopamine group had a treatment failure (0/31; 0%); (16%) of 32 infants failed to respond to dobutamine ( p = 0.028). Success was attained at ≤10 μg/kg per minute in 30 (97%) of 31 infants given dopamine and in 22 (69%) of 32 infants given dobutamine ( p <0.01). Among those treated successfully, the increase in mean arterial blood pressure was significantly higher in those given dopamine (mean, 11.3 vs 6.8 mm Hg; p = 0.003). We conclude that dopamine is more effective than dobutamine for the early treatment of hypotension in preterm infants with respiratory distress syndrome. (J P EDIATR 1994;125:117-22)