Dopamine for prevention of morbidity and mortality in term newborn infants with suspected perinatal asphyxia

Dopamine to improve outcomes in newborn infants with a suspected lack of oxygen during birth. A lack of oxygen around the time of birth (perinatal asphyxia) can cause death and long-term illness in newborn infants. It is indicated by a low Apgar score five minutes after birth and acidic umbilical cord blood (acidosis). An infant experiencing asphyxia may need urgent resuscitation, oxygen and supported breathing (assisted ventilation). Often they have low blood pressure and poor heart function. The drug dopamine stimulates the heart and is used to improve blood flow to the brain and other organs to reduce brain and other organ damage. Possible adverse events from giving such an agent include damage with the umbilical venous catheter and heart irregularities (arrhythmias). The review authors searched the medical literature and were able to find only one small randomised controlled trial. The 14 infants included in the trial had a birthweight over 2000 g and were enrolled at a mean age of 10 hours. They had received ventilatory support and fluid expansion after birth. Infants treated with low dose dopamine (2.5 microg/kg/min) did not differ from the infants receiving placebo (dextrose water) in the number who died before discharge from hospital. Neurodevelopmental disability was similar in both groups, in all infants randomised and in survivors. The timing of assessments was variable. These findings are limited with only one small study in which three of 12 survivors were lost to follow up.

Authors' conclusions: 

There is currently insufficient evidence from randomised controlled trials that the use of dopamine in term infants with suspected perinatal asphyxia improves mortality or long-term neurodevelopmental outcome. The question of whether dopamine improves outcome for term infants with suspected perinatal asphyxia has not been answered. Further research is required to determine whether or not the use of dopamine improves mortality and long-term morbidity for these infants and if so, issues such as which infants, at what dose and with what co-interventions should be addressed.

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Background: 

Perinatal asphyxia remains an important condition with significant mortality and long-term morbidity. Multisystem involvement including hypotension and low cardiac output is common in infants with perinatal asphyxia. Dopamine is commonly used for infants with hypotension of any etiology, with the goal of improving cardiac output and preventing its detrimental consequences.

Objectives: 

To determine if dopamine, compared to placebo, no treatment, volume or another inotrope reduces morbidity and mortality in term newborn infants with suspected perinatal asphyxia.

Search strategy: 

The standard search strategy of the Neonatal Review Group was used. Searches were conducted of the Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2002), MEDLINE (1966 to March 2002), previous reviews including cross references, abstracts and conference proceedings (Perinatal Society of Australia and New Zealand 1998-2002 and Pediatric Academic Societies meetings 1998-2001).

Selection criteria: 

Randomised controlled trials comparing dopamine with placebo, no treatment, other inotropic agents, or volume in infants greater than 36 weeks gestation. Perinatal asphyxia could be suspected on the basis of a cord blood pH < 7.0, cord blood base excess < -16 mEq/L or 5 minute Apgar score < 6.

Data collection and analysis: 

Standard methods of the Cochrane Neonatal Review Group with use of relative risk (RR), risk difference (RD) and weighted mean difference (WMD). The fixed effects model using RevMan 4.1 was used for meta-analysis. Data from individual studies were only eligible for inclusion if at least 75% of participants were followed up.

Main results: 

Only one study (DiSessa 1981) was eligible. This study compared low dose dopamine at 2.5 mcg/kg/min with placebo (dextrose in water). This study enrolled 14 term infants with a 5 minute Apgar <6 and a systolic BP >=50 mmHg at a mean of 10 hours age. Seven infants only were randomised to treatment with dopamine and seven to receive placebo. No significant differences between these two groups were found for mortality or long term neurodevelopmental outcome. Length of hospitalisation was not significantly different between the two groups. No study was found that examined the effect of dopamine in infants with evidence of cardiovascular compromise, nor were any studies identified in which dopamine was compared to other inotropic agents for term infants with suspected asphyxia.

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