High Dose Dopamine for Treatment of Neonatal Hypotension 1111

Abstract

Dopamine doses of 10-20 mcg/kg/min are often avoided because alpha-adrenergic effects may decrease renal perfusion and impair urine output. However, some hypotensive neonates do not respond even to these doses, and require greater pressor support. Of 130 neonates treated with dopamine in 1991-1995, 24 (18.5%) required dopamine > 20 mcg/kg/min to achieve adequate blood pressure. We reviewed the data on these 24 infants. Doses of dopamine were 26 to 250 mcg/kg/min. Gestational age was 22-41 (29±6) weeks, and birth weight was 450 to 3845 (1505±1086) gr. The most common associated diagnosis included: RDS (n=18), pulmonary hypertension (n=5), sepsis (n=7), and barotrauma (n=10). Dopamine was infused at gradually increasing doses until adequate values of blood pressure (BP) were achieved. Urine output (UO) was also assessed. We compared results pre-treatment, while on“conventional” pressor doses, and while on “high-dose” dopamine. UO and BP were significantly higher (P <0.001) while on“high-dose” dopamine vs. the two preceding epochs. Data analyzed for the subgroup with birth weight <1500 gr. (n=15) was similar to the above. Overall survival was 45% (40% in the group with birth weight<1500gr). Incidence of severe IVH (grades 3 & 4) was 16% in the surviving infants with weight < 1500 gr. We conclude that there is an increasing pressor response to dopamine beyond 20 mcg/kg/min., and that urine output (UO) is not suppressed by these high doses; in fact, hemodynamic improvement may have a beneficial net effect on renal function. Table