Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2002;2002(3):CD003213.
doi: 10.1002/14651858.CD003213.

Dopamine versus no treatment to prevent renal dysfunction in indomethacin-treated preterm newborn infants

K Barrington  1 , L P Brion
Affiliations

Dopamine versus no treatment to prevent renal dysfunction in indomethacin-treated preterm newborn infants

K Barrington et al. Cochrane Database Syst Rev. 2002.

Abstract

Background: Indomethacin therapy for closure of patent ductus arteriosus frequently causes oliguria, and occasionally more serious renal dysfunction. Low dose dopamine has been suggested as a means for preventing this side effect.

Primary objective: To determine whether dopamine therapy may prevent indomethacin-mediated deterioration in renal function in the preterm newborn infant without serious adverse effects.

Secondary objective: To assess the effects of dopamine on the above variables in two subgroups: (1) patients given indomethacin as prophylaxis of intraventricular hemorrhage, and (2) patients given indomethacin as treatment of patent ductus arteriosus

Search strategy: Standard methods of the Cochrane Neonatal Review Group (CNRG) were used. We searched MEDLINE (1966-2001) using PubMed as the search engine, EMBASE (1974-2001) and the Cochrane Controlled Trials Register (CCTR) from the Cochrane Library (Issue 3, 2001). In addition we contacted the principal investigators if necessary to ascertain the required information.

Selection criteria: Randomized or quasi-randomized studies of the effects of dopamine on urine output, glomerular filtration rate, fluid balance or incidence of renal failure, in preterm newborn infants receiving indomethacin. The comparison group should have received no dopamine.

Data collection and analysis: We used the standard methods of the Cochrane Collaboration and those of the CNRG. The primary outcomes of interest were: mortality before discharge; intraventricular hemorrhage, grade three or four; cystic periventricular leukomalacia; renal failure (either oliguria, defined as a urine output less than 1 ml/kg/hour or an elevation in creatinine by more than 40 micromoles/L); failure to close the ductus arteriosus; need for surgical PDA ligation. For categorical outcomes, we calculated typical estimates for relative risk and risk difference. For continuous outcomes the weighted mean difference (WMD) was calculated. Fixed effect models were assumed for meta-analysis.

Main results: Three studies were found (total number randomized patients, 75) which fulfilled the entry criteria for this review. All were single center trials which enrolled NICU patients receiving indomethacin for symptomatic patent ductus arteriosus. There are no (or only partial) results for effects of dopamine on several of the primary outcomes, including death before discharge, serious intraventricular hemorrhage, cystic periventricular leukomalacia, or renal failure. There has been inadequate investigation of the effects of dopamine on cerebral perfusion or cardiac output, or GI complications, or endocrine toxicity. Dopamine improved urine output [WMD 0.68 ml/kg/hour (95% CI 0.22, 1.44)], but there was no evidence of effect on serum creatinine (WMD 2.04 micromoles/liter, CI -17.90, 21.97) or the incidence of oliguria (urine output < 1 ml/kg/hour) (RR 0.73, CI 0.35, 1.54). There was no evidence of effect of dopamine on the frequency of failure to close the ductus arteriosus (RR 1.11, CI 0.56, 2.19).

Reviewer's conclusions: There is no evidence from randomized trials to support the use of dopamine to prevent renal dysfunction in indomethacin-treated preterm infants.

PubMed Disclaimer

Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 Dopamine vs no treatment in indomethacin‐treated infants with PDA, Outcome 1 Urine output (mL/kg/hour).
1.2
1.2. Analysis
Comparison 1 Dopamine vs no treatment in indomethacin‐treated infants with PDA, Outcome 2 Serum creatinine concentration (micromoles/liter).
1.3
1.3. Analysis
Comparison 1 Dopamine vs no treatment in indomethacin‐treated infants with PDA, Outcome 3 Fractional sodium excretion (%).
1.4
1.4. Analysis
Comparison 1 Dopamine vs no treatment in indomethacin‐treated infants with PDA, Outcome 4 Oliguria (urine output < 1 ml/kg/hour).
1.5
1.5. Analysis
Comparison 1 Dopamine vs no treatment in indomethacin‐treated infants with PDA, Outcome 5 Failure to close the ductus arteriosus.
See this image and copyright information in PMC

References

References to studies included in this review

Baenziger 1999 {published data only}
    1. Baenziger O, Waldvogel K, Ghelfi D, Arbenz U, Fanconi S. Can dopamine prevent the renal side effects of indomethacin? A prospective randomized clinical study. Klinische Padiatrie 1999;211:438‐41. - PubMed
Fajardo 1992 {published data only}
    1. Fajardo CA, Whyte RK, Steele BT. Effect of dopamine on failure of indomethacin to close the patent ductus arteriosus [see comments]. Journal of Pediatrics 1992;121:771‐5. - PubMed
Seri 1984 {published data only}
    1. Seri I, Tulassay T, Kiszel J, Csomor S. The use of dopamine for the prevention of the renal side effects of indomethacin in premature infants with patent ductus arteriosus. International Journal of Pediatric Nephrology 1984;5:209‐14. - PubMed

References to studies excluded from this review

Seri 1988 {published data only}
    1. Seri I, Hajdu J, Kiszel J, Tulassay T, Aperia A. Effect of low‐dose dopamine infusion on urinary prostaglandin E2 excretion in sick, preterm infants. European Journal of Pediatrics 1988;147:616‐20. - PubMed
Tulassay 1983 {published data only}
    1. Tulassay T, Seri I, Machay T, Kiszel J, Varga J, Csomor S. Effects of dopamine on renal functions in premature neonates with respiratory distress syndrome. International Journal of Pediatric Nephrology 1983;4:19‐23. - PubMed

References to studies awaiting assessment

Additional references

Alpan 1985
    1. Alpan G, Eyal F, Vinograd I, Udassin R, Amir G, Mogle P, Glick B. Localized intestinal perforations after enteral administration of indomethacin in premature infants. Journal of Pediatrics 1985;106:277‐81. - PubMed
Barrington 1994
    1. Barrington KJ, Fox M. Predicting oliguria following indomethacin for treatment of patent ductus arteriosus. American Journal of Perinatology 1994;11:220‐2. - PubMed
Bergamo 1989
    1. Bergamo RR, Cominelli F, Kopple JD, Zipser RD. Comparative acute effects of aspirin, diflunisal, ibuprofen and indomethacin on renal function in healthy man. American Journal of Nephrology 1989;9:460‐3. - PubMed
Brion 2001
    1. Brion LP, Campbell DE. Furosemide for symptomatic patent ductus arteriosus in indomethacin‐treated infants (Cochrane Review). Cochrane Database of Systematic Reviews 2001, Issue 2. [DOI: 10.1002/14651858.CD001148] - DOI - PubMed
Chemtob 1991
    1. Chemtob S, Beharry K, Barna T, Varma DR, Aranda JV. Differences in the effects in the newborn piglet of various nonsteroidal antiinflammatory drugs on cerebral blood flow but not on cerebrovascular prostaglandins. Pediatric Research 1991;30:106‐11. - PubMed
Cheung 1996
    1. Cheung PY, Barrington KJ. Renal dopamine receptors: mechanisms of action and developmental aspects. Cardiovascular Research 1996;31:2‐6. - PubMed
Cifuentes 1979
    1. Cifuentes RF, Olley PM, Balfe JW, Radde IC, Soldin SJ. Indomethacin and renal function in premature infants with persistent patent ductus arteriosus. J Pediatr 1979;95:583‐7. - PubMed
Clyman 1996
    1. Clyman RI. Recommendations for the postnatal use of indomethacin: an analysis of four separate treatment strategies. Journal of Pediatrics 1996;128:601‐7. - PubMed
Corazza 1984
    1. Corazza MS, Davis RF, Merritt TA, Bejar R, Cvetnic W. Prolonged bleeding time in preterm infants receiving indomethacin for patent ductus arteriosus. Journal of Pediatrics 1984;105:292‐6. - PubMed
Fowlie 1997
    1. Fowlie PW. Intravenous indomethacin for preventing mortality and morbidity in very low birth weight infants. Cochrane Database of Systematic Reviews 1997, Issue 3. [DOI: 10.1002/14651858.CD000174] - DOI - PubMed
Goldberg 1972
    1. Goldberg LI. Cardiovascular and renal actions of dopamine: potential clinical applications. Pharmacological Reviews 1972;24:1‐29. - PubMed
Kellum 2001
    1. Kellum JA, M Decker J. Use of dopamine in acute renal failure: a meta‐analysis. Critical Care Medicine 2001;29:1526‐31. - PubMed
Kuhl 1985
    1. Kuhl G, Wille L, Bolkenius M, Seyberth HW. Intestinal perforation associated with indomethacin treatment in premature infants. European Journal of Pediatrics 1985;143:213‐6. - PubMed
Manoogian 1988
    1. Manoogian C, Nadler J, Ehrlich L, Horton R. The renal vasodilating effect of dopamine is mediated by calcium flux and prostacyclin release in man. Journal of Clinical Endocrinology and Metabolism 1988;66:678‐83. - PubMed
McCrory 1997
    1. McCrory C, Cunningham J. Low‐dose dopamine: will there ever be a scientific rationale?. British Journal of Anaesthesia 1997;78:350‐1. - PubMed
Mosca 1997
    1. Mosca F, Bray M, Lattanzio M, Fumagalli M, Tosetto C. Comparative evaluation of the effects of indomethacin and ibuprofen on cerebral perfusion and oxygenation in preterm infants with patent ductus arteriosus. Journal of Pediatrics 1997;131:549‐54. - PubMed
Nehgme 1992
    1. Nehgme RA, O'Connor TZ, Lister G, Bracken MB. Patent Ductus Arteriosus. In: Sinclair JC, Bracken MB editor(s). Effective Care of the Newborn Infant. Oxford: Oxford University Press, 1992.
Pezzati 1999
    1. Pezzati M, Vangi V, Biagiotti R, Bertini G, Cianciulli D, Rubaltelli FF. Effects of indomethacin and ibuprofen on mesenteric and renal blood flow in preterm infants with patent ductus arteriosus. Journal of Pediatrics 1999;135:733‐8. - PubMed
Prins 2001
    1. Prins I, Plotz FB, Uiterwaal CS, Vught HJ. Low‐dose dopamine in neonatal and pediatric intensive care: a systematic review. Intensive Care Med 2001;27:206‐10. - PubMed
Smith 1995
    1. Smith WL, DeWitt DL. Biochemistry of prostaglandin endoperoxide H synthase‐1 and synthase‐2 and their differential susceptibility to nonsteroidal anti‐inflammatory drugs. Seminars in Nephrology 1995;15:179‐94. - PubMed
Speziale 1999
    1. Speziale MV, Allen RG, Henderson CR, Barrington KJ, Finer NN. Effects of ibuprofen and indomethacin on the regional circulation in newborn piglets. Biology of the Neonate 1999;76:242‐52. - PubMed
Thompson 1994
    1. Thompson BT, Cockrill BA. Renal‐dose dopamine: A siren song?. Lancet 1994;344:7‐8. [MEDLINE: ] - PubMed
Van den Berghe 1996
    1. Berghe G, Zegher F. Anterior pituitary function during critical illness and dopamine treatment. Critical Care Medicine 1996;24:1580‐90. - PubMed
Van Wassenaer 1997
    1. Wassenaer AG, Kok JH, Dekker FW, Vijlder JJ. Thyroid function in very preterm infants: Influences of gestational age and disease. Pediatr Res 1997;42:604‐9. - PubMed
Van Wassenaer 1999
    1. Wassenaer AG, Kok JH, Briet JM, Pijning AM, deVijlder JJM. Thyroid function in very preterm newborns: Possible implications. Thyroid 1999;9:85‐91. - PubMed
Vane 1998
    1. Vane JR, Botting RM. Mechanism of action of anti‐inflammatory drugs. Advances in Experimental Medicine and Biology 1997;433:131‐8. - PubMed

References to other published versions of this review

Barrington 2002
    1. Barrington KJ, Brion LP. versus no treatment to prevent renal dysfunction in indomethacin‐treated preterm newborn infants. Cochrane Database of Systematic Reviews 2002, Issue 3. [DOI: 10.1002/14651858.CD003213] - DOI - PMC - PubMed

Publication types

MeSH terms

LinkOut - more resources