Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. May 8, 2016; 5(2): 212-222
Published online May 8, 2016. doi: 10.5409/wjcp.v5.i2.212
Should dopamine be the first line inotrope in the treatment of neonatal hypotension? Review of the evidence
Sadaf I Bhayat, Harsha M S Gowda, Michael Eisenhut
Sadaf I Bhayat, Michael Eisenhut, Harsha MS Gowda, Neonatal and Paediatric Department, Luton and Dunstable NHS Foundation Trust, Luton LU4 0DZ, United Kingdom
Author contributions: Bhayat SI and Gowda HMS contributed to literature search, review, analysis, and initial drafting and revision of the manuscript; Eisenhut M contributed to critical revision, editing, and approval of the final version.
Conflict-of-interest statement: No potential conflict of interest. No financial support.
Data sharing statement: Statistical code and dataset available from the corresponding author at sadafbhayat@gmail.com.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sadaf I Bhayat, MD, Neonatal and Paediatric Department, Luton and Dunstable NHS Foundation Trust, Lewsey Rd, Luton LU4 0DZ, United Kingdom. sadafbhayat@gmail.com
Telephone: +44-1582-491166
Received: July 29, 2015
Peer-review started: July 31, 2015
First decision: December 4, 2015
Revised: December 17, 2015
Accepted: January 16, 2016
Article in press: January 19, 2016
Published online: May 8, 2016
Processing time: 278 Days and 13.1 Hours
Abstract

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.

Keywords: Hypotension; Preterm; Inotrope; Dopamine; Dobutamine; Adrenaline/epinephrine; Corticosteroids

Core tip: Hypotension is a common feature in the preterm infant. The aim of this systematic review was to determine, after review of evidence, if dopamine would make a good first line drug therapy for hypotension in the neonatal population. Dopamine was shown across trials to increase blood pressure more effectively than dobutamine. There was no difference in morbidity and mortality outcomes when dopamine was compared to hydrocortisone or adrenaline. In preterm infants, dopamine is the most studied drug, and in general safer than others to use, we therefore cautiously suggest it could be used as first line treatment in hypotension.