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      Dopamine versus dobutamine for hypotensive preterm infants

      systematic-review
      ,
      Cochrane Neonatal Group
      The Cochrane Database of Systematic Reviews
      John Wiley & Sons, Ltd

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          Abstract

          Background

          Inotropes are widely used in preterm infants to treat systemic hypotension. The most commonly used drugs are dopamine and dobutamine. These agents have different modes of action which may result in different haemodynamic effects.

          Objectives

          To compare the effectiveness and safety of dopamine and dobutamine in the treatment of systemic hypotension in preterm infants.

          Search methods

          Searches of electronic and other databases were performed including MEDLINE (1966‐2002), EMBASE (1988‐2002), Science Citation Index (1981‐2002), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2003). Previous reviews were searched for references to relevant trials and leading authors in the field were contacted for information about other published and unpublished studies.

          Selection criteria

          Randomised controlled trials where short and/or long term effects of treatment with dopamine and dobutamine for the treatment of systemic arterial hypotension were compared were selected for this review. Trials studying newborn infants born before 37 completed weeks gestation and less than 28 days of age were eligible for inclusion. Systemic arterial hypotension was not defined specifically, but accepted as defined in individual studies. Studies were not limited by birthweight, lower gestational age threshold or by route or duration of administration of inotropic agents. Study quality and eligibility were assessed independently by each reviewer.

          Data collection and analysis

          Data extraction was performed independently by each reviewer, with differences being resolved by discussion. The following outcomes were determined: mortality in the neonatal period, long term neurodevelopmental outcome, radiological evidence of severe neurological injury, short term haemodynamic changes and incidence of adverse effects. The effect of interventions was expressed either as Relative Risk (RR), Risk Difference (RD) or as Weighted Mean Difference (WMD) with their 95% Confidence Interval (CI).

          Main results

          Five trials met the pre‐defined criteria for inclusion in this review. There was no evidence of a significant difference between dopamine and dobutamine in terms of neonatal mortality (RD 0.02 95% CI ‐0.12 to 0.16), incidence of periventricular leukomalacia (RD ‐0.08, 95% CI ‐0.19 to 0.04), or severe periventricular haemorrhage (RD ‐0.02, 95% CI ‐0.13 to 0.09). Dopamine was more successful than dobutamine in treating systemic hypotension, with fewer infants having treatment failure (RD ‐0.23, 95% CI ‐0.34 to ‐0.13; NNT = 4.4, 95% CI 2.9 to 7.7). Treatment with dobutamine was associated with a significantly greater increase in left ventricular output in the single study reporting that outcome. There was no evidence of a significant difference between the two agents with respect to the incidence of tachycardia (RD ‐0.06, 95% CI ‐0.25 to 0.14). None of the studies reported the incidence of adverse long term neurodevelopmental outcome.

          Authors' conclusions

          Dopamine is more effective than dobutamine in the short term treatment of systemic hypotension in preterm infants. There was no evidence of an effect on the incidence of adverse neuroradiological sequelae (severe periventricular haemorrhage and/or periventricular leucomalacia), or on the incidence of tachycardia. However, in the absence of data confirming long term benefit and safety of dopamine compared to dobutamine, no firm recommendations can be made regarding the choice of drug to treat hypotension.

          Plain language summary

          Dopamine versus dobutamine for hypotensive preterm infants

          Dopamine improves low blood pressure (hypotension) in preterm babies more effectively than dobutamine in the short‐term, but evidence on safety and long‐term effectiveness is needed. Hypotension may cause brain injury and other serious problems for preterm babies (born before 37 weeks). Treatment aims to maintain blood flow to the brain and other organs, by using fluids or drugs to increase blood pressure. Inotrope drugs, including dopamine and dobutamine, are commonly used to increase blood pressure. However, the safest and most effective drug for treating hypotension in preterm babies has been unclear. The review found that dopamine was more effective than dobutamine for short‐term treatment, but the effects of these drugs on long‐term outcomes is unknown. More trials are needed.

          Related collections

          Author and article information

          Contributors
          nim.subhedar@lwh.nhs.uk
          Journal
          Cochrane Database Syst Rev
          Cochrane Database Syst Rev
          14651858
          10.1002/14651858
          The Cochrane Database of Systematic Reviews
          John Wiley & Sons, Ltd (Chichester, UK )
          1469-493X
          21 July 2003
          July 2003
          14 September 2008
          : 2003
          : 3
          : CD001242
          Affiliations
          Liverpool Women's NHS Foundation Trust deptNeonatal Intensive Care Unit Crown Street Liverpool UK L8 7SS
          Liverpool Women's Hospital deptNeonatal Intensive Care Unit Crown Street Liverpool UK L8 7SS
          Article
          PMC7061491 PMC7061491 7061491 CD001242 CD001242
          10.1002/14651858.CD001242
          7061491
          12917901
          5952153d-a521-4d79-ab97-0a35c66faf31
          Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
          History
          Categories
          Child health
          Neonatal care
          Cardiovascular Disorders

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