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European Journal of Pediatrics

, Volume 177, Issue 9, pp 1335–1342 | Cite as

Epinephrine versus dopamine in neonatal septic shock: a double-blind randomized controlled trial

  • Kishore Baske
  • Shiv Sajan Saini
  • Sourabh Dutta
  • Venkataseshan Sundaram
Original Article

Abstract

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.

Clinical Trial registry name and registration number: The study was registered with Clinical Trial Registry of India CTRI/2015/10/006285.

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.

Keywords

Dopamine Epinephrine Neonate Septic shock Vasoactive agents 

Abbreviations

BP

Blood pressure

BPD

Bronchopulmonary dysplasia

CFT

Capillary filling time

CO

Cardiac output

CRIB II

Clinical risk index for babies score

DBP

Diastolic blood pressure

HR

Heart rate

LVO

Left ventricular output

IVH

Intra-ventricular haemorrhage

NEC

Necrotising enterocolitis

ROP

Retinopathy of prematurity

SBP

Systolic blood pressure

SVR

Systemic vascular resistance

Notes

Authors’ contributions

• 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

Human participants.

Informed consent

Obtained from one of the parents of all neonates.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Neonatology, Department of PediatricsPost Graduate Institute of Medical Education and ResearchChandigarhIndia

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