Epinephrine versus dopamine in neonatal septic shock: a double-blind randomized controlled trial
We compared epinephrine and dopamine as a first-line vasoactive drug in 40 neonates (enrolled in two gestational age strata ≤ 306/7 and ≥ 310/7 weeks) with fluid-refractory septic shock. Epinephrine or dopamine was initiated at 0.2 or 10 μg/kg/min, respectively. If shock persisted after 15 min, epinephrine or dopamine was increased to 0.3 or 15 μg/kg/min, respectively (16–30 min), and thereafter to 0.4 or 20 μg/kg/min (31–45 min). Proportion of neonates achieving ‘reversal of shock’ (defined as systolic and diastolic BP > fifth centile and capillary filling time < 3 s and left ventricular output ≥ 150 mL/kg/min) by 45 min [5 (25%) vs 6 (30%), RR 0.83 (95% CI 0.30, 2.29)]; haemodynamic stability (shock reversal for ≥ 120 min without escalation of vasoactive drugs) anytime during therapy [10 (50%) vs 6 (30%), RR 1.67 (95% CI 0.75, 3.71)]; and all-cause mortality by 28 days [14 (70%) vs 16 (80%), RR 0.87 (95% CI 0.61, 1.26)] were comparable in the epinephrine and dopamine groups, respectively. On stratified analysis, we observed an interaction of gestational age strata with the group of allocation favouring epinephrine in neonates ≤ 306/7 weeks.
Conclusion: Epinephrine (0.2–0.4 μg/kg/min) and dopamine (10–20 μg/kg/min) had comparable efficacy and safety in neonatal septic shock.
What is Known:
• The choice of vasoactive drugs in neonatal septic shock is empirical and dopamine is the conventional first-line vasoactive drug.
• There are no randomized controlled trials comparing dopamine and epinephrine in neonatal septic shock.
What is New:
• In this study, epinephrine and dopamine had comparable efficacy and safety as a first-line vasoactive drug in management of neonatal septic shock.
• On stratified analysis in a limited sample, epinephrine was associated with better outcomes in neonates ≤ 306/7 weeks.
KeywordsDopamine Epinephrine Neonate Septic shock Vasoactive agents
Capillary filling time
- CRIB II
Clinical risk index for babies score
Diastolic blood pressure
Left ventricular output
Retinopathy of prematurity
Systolic blood pressure
Systemic vascular resistance
• Dr. Kishore Baske: designed the data collection instruments, enrolled the patients, collected the data, drafted the initial manuscript and approved the final manuscript as submitted.
• Dr. Shiv Sajan Saini: conceptualized and designed the study, coordinated and supervised data collection, performed functional echocardiography, performed the data analysis, reviewed and revised the manuscript and approved the final manuscript as submitted
• Dr. Sourabh Dutta: critically reviewed the manuscript and approved the final manuscript as submitted
• Venkataseshan Sundaram: coordinated and supervised data collection, reviewed and revised the manuscript and approved the final manuscript as submitted
Compliance with ethical standards
Conflict of interest
There is no potential, perceived, or real conflict of interest. The sponsor had no role in planning, conduct, analysis or publication of the study.
Research involving human participants and/or animals
Obtained from one of the parents of all neonates.
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