Dopamine and Dobutamine Use in Preterm or Low Birth Weight Neonates in the Premier 2008 Database

• Published in: Clinical therapeutics Vol. 33; no. 12; pp. 2082 - 2088
• Main Authors: Lasky, Tamar, PhD, Greenspan, Jay, MD, MBA, Ernst, Frank R., PharmD, Gonzalez, Liliana, PhD
• Format: Journal Article
• Language: English
• Published: Bridgewater, NJ EM Inc USA 01.12.2011; Elsevier; Elsevier Limited
• Subjects: Babies; Biological and medical sciences; Birth weight; Cardiovascular Agents - adverse effects; Cardiovascular Agents - therapeutic use; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - mortality; Cardiovascular Diseases - physiopathology; Chi-Square Distribution; Databases as Topic; Diseases of mother, fetus and pregnancy; dobutamine; Dobutamine - adverse effects; Dobutamine - therapeutic use; dopamine; Dopamine - adverse effects; Dopamine - therapeutic use; Drug Utilization; Female; Gynecology. Andrology. Obstetrics; Hospitalization; Humans; Infant Mortality; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Information systems; Internal Medicine; Male; Medical Education; Medical sciences; Mortality; neonates; pharmacoepidemiology; Pharmacology. Drug treatments; Practice Patterns, Physicians' - statistics & numerical data; Pregnancy. Fetus. Placenta; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Risk Factors; Studies; Treatment Outcome; United States > US; Utah; database; dobutamine; neonates; hospitalization; dopamine; pharmacoepidemiology; Human; Agonist; Cardiotonic agent; Dopamine; Pregnancy disorders; Low birth weight; Premature delivery; Dobutamine; β-Adrenergic receptor agonist; Hospitalization; Pharmacovigilance; Catecholamine; Epidemiology; Newborn diseases; β1-Adrenergic receptor; Newborn; Prematurity; Neurotransmitter; Database
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2011.11.001

Abstract Background Dobutamine and dopamine are off-patent drugs prioritized by the National Institute of Child Health and Human Development and US Food and Drug Administration for further study under the Best Pharmaceuticals for Children Act. Both agents are used to manage cardiac insufficiency in preterm neonates and are subject to controversy among neonatologists. Among the controversies are outcome measures (blood pressure vs end organ perfusion) and long-term effects. Objectives We analyzed retrospective hospitalization data to (1) describe the use of dopamine and dobutamine in low birth weight (LBW) or preterm infants in a large sample and (2) explore the potential of using observational data to describe outcomes in LBW or preterm infants treated with dopamine or dobutamine. Methods Inpatient data were extracted from the Premier database to calculate the prevalence of use of dopamine and dobutamine among neonates in 2008. Prevalence of use was calculated by categorizing patients as ever or never having received dopamine or dobutamine. We compared mortality in the neonates by using Cox proportional hazards models to identify variables associated with survival and to control for their effects. Results Out of 877,201 pediatric hospitalizations in 2008, 65,216 were neonates and had data available about dopamine and dobutamine use. Of these, 7459 were preterm or LBW and included 1143 very LBW (VLBW) neonates. Dopamine alone was given to 194 VLBW neonates, dobutamine alone was given to 14, and both dopamine and dobutamine were given to 79 neonates. For the VLBW neonates, probability of treatment with dopamine or dobutamine varied almost 10-fold from 4.4% to 38.4% at 11 hospitals and did not differ by 3M APR-DRG (all patient refined diagnosis related group) severity of illness or 3M APR-DRG risk of mortality. Conclusions Our data suggest the prevalence of dopamine or dobutamine use was 4.9% in preterm or LBW neonates and 25.1% in VLBW neonates. Treatment with dopamine alone was more common than treatment with dobutamine alone. There was no difference in mortality between neonates treated with dopamine compared with treatment with dobutamine, but access to charts and clinical details are required to conduct a comparative effectiveness study.