DOES THE USE OF EPINEPHRINE AS AN ADJUNCT INOTROPIC THERAPY IN PRETERM INFANTS REDUCE MORTALITY?

Abstract

Treatments for hypotensive preterm infants include volume expansion, inotropic agents, and corticosteroids. Common inotropic agents include dopamine, dobutamine, and epinephrine. There are few studies describing the effects and efficacy of inotropes, particularly in terms of survival. This paucity of information led to the hypothesis that in infants ≤ 1,500 g or ≤ 32 weeks9 gestation receiving inotropic support, there will be no difference in mortality when epinephrine is added as an adjunctive inotropic agent. A retrospective chart review of patients admitted to Kosair Children9s Hospital NICU from December 2002 to December 2005 was performed. Preterm infants ≤ 1,500 g or ≤ 32 weeks gestation who received inotropic support were included. Patients were excluded for life-threatening congenital defects. Those infants who received epinephrine (epi) as an adjunctive inotropic agent were compared with infants who did not receive epinephrine (no-epi). Admission demographic data, BP, ABGs, and UOP were recorded. SNAPPE-II and CRIB-II scores were calculated. BP, HR, and ABGs were recorded prior to initiation and during inotropic support. The primary outcome variable was death. Data were analyzed with SPSS for Windows (V. 14; SPSS Inc). Eighty-eight infants were considered for analysis. There was a significant difference in BW and EGA between the groups; however, there was no difference in admitting diagnoses, BP, ABG, or UOP. There was a trend toward higher predicted mortality in the epi group. Prior to intervention, there was no difference in BP, HR, or ABGs. With intervention, the epi group demonstrated a higher maximum HR (p