61 Epinephrine as a First Line Inotrope in Newborns Less than 1000 Grams

Abstract

There is very little published data on the use of epinephrine for treatment of hypotension in the newborn. More often than not epinephrine is used when other inotropes have been unsuccessful. The purpose of this review was to document our experience with epinephrine as a first line inotropic agent in a cohort of hypotensive premature infants 1000 grams or less. We reviewed all patients 1000 grams or less who were admitted to our unit over a three year period from 2000–2002 inclusive. Patients were identified from a pharmacy database and from chart review. Information was entered onto an excel database and was subsequently transferred to SPSS spreadsheet for analysis. Ninety patients 1000 grams or less were admitted during this time period. 10 patients were identified who met our criteria for hypotension (absolute blood pressure value and signs of systemic hypoperfusion) and received inotropic support. The mean gestational age of this cohort was 25.4±1.6 weeks ( range 23–28 weeks) and birth weight was 743±170 grams (500–1000 g ). 80% had received a full course of steroids. The mean blood pressure prior to starting an epinephrine infusion was 18 mmHg. 9 patients were started on epinephrine between 3 hrs and 16 hrs of age. The other patient started epinephrine at 11 days. The average duration of use was 20.6 hrs. SNAP PE-II scores ranged from 59–119. The mortality rate was 50% for the group. Primary outcome measures included physiological responses (blood pressure, heart rate, urine output) and laboratory variables (Ph, anion gap, base deficit, glucose). There was a significant increase in blood pressure and heart rate one, 2 and 4 hrs post infusion from baseline measurements. Urine output increased significantly following infusion. There was no significant change in ph, anion gap or base deficit following infusion. There was a significant increase in blood glucose necessitating insulin infusion. Epinephrine is an effective inotrope in this subgroup of patients. It is associated with a sustained increase in blood pressure and urine output. One potential adverse effect was an increase in serum glucose during therapy necessitating insulin infusion.