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Should dopamine be the first line inotrope in the treatment of neonatal hypotension? Review of the evidence

World Journal of Clinical Pediatrics 2016年第2期5卷 212-222页

作者： Sadaf I Bhayat Harsha MS Gowda Michael Eisenhut Neonatal and Paediatric Department Luton and Dunstable NHS Foundation Trust

AIM: To determine if dopamine is effective in treating neonatal hypotension and safe to use comparing to other inotropes. METHODS: This is a review of evidence on inotropic treatment of neonatal hypotension. Databases searched were MEDLINE and the Cochrane Library, a total of 134 studies were identified. Only studies with high quality evidence(level 1a and b and 2a) were included. After review, only eight studies were included in the final analysis. Pooled risk ratios derived for each outcome [Mantel-Haenzel(M-H) fixed effect] with CI, as reported in the Cochrane reviews were plotted in forest plot form. RESULTS: Eight articles met inclusion criteria, which all included treatment in preterm infants. Dopamine increased mean arterial blood pressure(BP)(n = 163; r = 0.88, 95%CI: 0.76 to 0.94) and systolic BP(n = 142; r = 0.81, 95%CI: 0.42 to 0.94) comparing to placebo. Dopamine has been shown overall to be statistically more effective in increasing BP than dobutamine(n = 251, r = 0.26, 95%CI: 0.20-0.32). However there were no differences in short term outcomes(periventricular leucomalacia, periventricular haemorrhage) and mortality between both drugs. There is no statistical evidence of dopamine being more effective than adrenaline or corticosteroids. There was no difference in morbidity and mortality outcomes when dopamine was compared to hydrocortisone(RR 1.81, 95%CI: 0.18 to 18.39) or adrenaline. CONCLUSION: In preterms, dopamine is the most studied drug, and we suggest it could be used as first line treatment in hypotension.

关键词： Hypotension Preterm Inotrope Dopamine Dobutamine adrenaline/epinephrine Corticosteroids

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