The Effect of Dopamine versus Norepinephrine on the Outcome of Pediatric Septic Shock

Abstract

Background: Septic shock is a leading cause of mortality and morbidity among children all over the world. Vasoactive therapy must be initiated in patients who have not improved after fluid resuscitation. Aim of work: The aim of this study was to compare the effect of dopamine versus norepinephrine on the outcome of pediatric septic shock. Patients and methods: The study was a prospective observational study that was conducted on 40 children aged from 1 month to 12 years who were admitted to the emergency department. They were assigned by the treating physicians to two groups: 1) Group A: 20 patients who received dopamine (5-20 mcg/kg/min). 2) Group B: 20 patients who received norepinephrine (1-1.5 mcg/kg/min). Clinical, hemodynamic, and laboratory data were recorded and compared using appropriate statistical tests. Results: Baseline characteristics for the 40 children enrolled were nearly similar. There was a significantly higher mortality rate in the dopamine group compared with the norepinephrine one (P < 0.05). As in the dopamine group, 15 patients died out of 20 patients, while in the norepinephrine group 8 patients died out of 20 patients, (75% vs. 40%, p=0.025). Stepwise logistic regression analysis revealed that PRISM-24 (p=0.001), drug (p=0.019), and MODS (p=0.003) could independently predict the mortality in septic shock patients. Conclusions: Norepinephrine was associated with an increased response to treatment and decreased risk of death in children with septic shock as compared to dopamine. Dopamine, PRISM-24, and MODS could independently predict the mortality in children with septic shock.