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Meta-Analysis
. 2002;2002(3):CD003484.
doi: 10.1002/14651858.CD003484.

Dopamine for prevention of morbidity and mortality in term newborn infants with suspected perinatal asphyxia

R Hunt  1 , D Osborn
Affiliations
Meta-Analysis

Dopamine for prevention of morbidity and mortality in term newborn infants with suspected perinatal asphyxia

R Hunt et al. Cochrane Database Syst Rev. 2002.

Abstract

Background: Perinatal asphyxia remains an important condition with significant mortality and long-term morbidity. Multisystem involvement including hypotension and low cardiac output is common in infants with perinatal asphyxia. Dopamine is commonly used for infants with hypotension of any etiology, with the goal of improving cardiac output and preventing its detrimental consequences.

Objectives: To determine if dopamine, compared to placebo, no treatment, volume or another inotrope reduces morbidity and mortality in term newborn infants with suspected perinatal asphyxia.

Search strategy: The standard search strategy of the Neonatal Review Group was used. Searches were conducted of the Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2002), MEDLINE (1966 to March 2002), previous reviews including cross references, abstracts and conference proceedings (Perinatal Society of Australia and New Zealand 1998-2002 and Pediatric Academic Societies meetings 1998-2001).

Selection criteria: Randomised controlled trials comparing dopamine with placebo, no treatment, other inotropic agents, or volume in infants greater than 36 weeks gestation. Perinatal asphyxia could be suspected on the basis of a cord blood pH < 7.0, cord blood base excess < -16 mEq/L or 5 minute Apgar score < 6.

Data collection and analysis: Standard methods of the Cochrane Neonatal Review Group with use of relative risk (RR), risk difference (RD) and weighted mean difference (WMD). The fixed effects model using RevMan 4.1 was used for meta-analysis. Data from individual studies were only eligible for inclusion if at least 75% of participants were followed up.

Main results: Only one study (DiSessa 1981) was eligible. This study compared low dose dopamine at 2.5 mcg/kg/min with placebo (dextrose in water). This study enrolled 14 term infants with a 5 minute Apgar <6 and a systolic BP >=50 mmHg at a mean of 10 hours age. Seven infants only were randomised to treatment with dopamine and seven to receive placebo. No significant differences between these two groups were found for mortality or long term neurodevelopmental outcome. Length of hospitalisation was not significantly different between the two groups. No study was found that examined the effect of dopamine in infants with evidence of cardiovascular compromise, nor were any studies identified in which dopamine was compared to other inotropic agents for term infants with suspected asphyxia.

Reviewer's conclusions: There is currently insufficient evidence from randomised controlled trials that the use of dopamine in term infants with suspected perinatal asphyxia improves mortality or long-term neurodevelopmental outcome. The question of whether dopamine improves outcome for term infants with suspected perinatal asphyxia has not been answered. Further research is required to determine whether or not the use of dopamine improves mortality and long-term morbidity for these infants and if so, issues such as which infants, at what dose and with what co-interventions should be addressed.

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Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 Dopamine versus control, Outcome 1 Mortality before hospital discharge (among all randomised).
1.2
1.2. Analysis
Comparison 1 Dopamine versus control, Outcome 2 Neurodevelopmental disability (among all randomised).
1.3
1.3. Analysis
Comparison 1 Dopamine versus control, Outcome 3 Death or neurodevelopmental disability (among all randomised).
1.4
1.4. Analysis
Comparison 1 Dopamine versus control, Outcome 4 Neurodevelopmental disability (among survivors examined).
See this image and copyright information in PMC

References

References to studies included in this review

DiSessa 1981 {published data only}
    1. DiSessa TG, Leitner M, Ti CC, Gluck L, Coen R, Friedman WF. The cardiovascular effects of dopamine in the severely asphyxiated neonate. Journal of Pediatrics 1981;99:772‐6. - PubMed
    1. Leitner MJ, DiSessa TG, Coen RW, Ti C. Cardiovascular effects of low dose dopamine in the severely asphyxiated infant. Pediatric Research 1980;14:447A. - PubMed

References to studies excluded from this review

Cason 1999 {published data only}
    1. Cason DL, Amaker D, Carter D, Sutherland D, Bhatia J. Randomized double‐blind trial of dopamine versus epinephrine for treatment of hypotension in premature infants with respiratory distress syndrome. Journal of Investigative Medicine 1999;47:119A.
Padbury 1990 {published data only}
    1. Padbury JF, Agata Y, Baylen BG, Ludlow JK, Polk D, Habib DM, Martinez AM. Pharmacokinetics of dopamine in critically ill newborn infants. Journal of Pediatrics 1990;117:472‐6. - PubMed
Phillipos 1996 {published data only}
    1. Phillipos EZ, Barrington KJ, Robertson MA. Dopamine versus epinephrine for inotropic support in the neonate: A randomized double blinded controlled trial. Pediatric Research 1996;39:238A.
Phillipos 2000 {published data only}
    1. Phillipos EZ, Robertson MA. A randomized double blinded controlled trial of dopamine versus epinephrine for inotropic support in premature infants <1750 grams. Pediatric Research 2000;47:425A.

Additional references

Aggarwal 1998
    1. Aggarwal P, Chaudhari S, Bhave S, Pandit A, Barve S. Clinical predictors of outcome in hypoxic ischaemic encephalopathy in term neonates. Annals of Tropical Paediatrics 1998;18:117‐21. - PubMed
Badawi 1998
    1. Badawi N, Kurinczuk JJ, Keogh JM, Alessandri LM, O'Sullivan F, Burton PR, Pemberton PJ, Stanley FJ. Intrapartum risk factors for newborn encephalopathy: the Western Australian case‐control study. BMJ 1998;317:1554‐8. - PMC - PubMed
Barberi 1999
    1. Barberi I, Calabro MP, Cordaro S, Gitto E, Sottile A, Prudente D, et al. Myocardial ischaemia in neonates with perinatal asphyxia. Electrocardiographic, echocardiographic and enzymatic correlations. European Journal of Pediatrics 1999;158:742‐7. - PubMed
Baumgart 2001
    1. Baumgart S, Graziani LJ. Predicting the future for term infants experiencing an acute neonatal encephalopathy: electroencephalogram, magnetic resonance imaging, or crystal ball?. Pediatrics 2001;107:588‐90. - PubMed
Bennhagen 1998
    1. Bennhagen RG, Weintraub RG, Lundstrom NR, Svenningsen NW. Hypoxic‐ischaemic encephalopathy is associated with regional changes in cerebral blood flow velocity and alterations in cardiovascular function. Biology of the Neonate 1998;73:275‐86. - PubMed
Burnard 1961
    1. Burnard ED, James LS. Failure of the heart after undue asphyxia at birth. Pediatrics 1961;28:545‐64. - PubMed
Cabal 1980
    1. Cabal LA, Devaskar U, Siassi B, Hodgman JE, Emmanouilides G. Cardiogenic shock associated with perinatal asphyxia in preterm infants. Journal of Pediatrics 1980;96:705‐10. - PubMed
Devictor 1988
    1. Devictor D, Verlhac S, Pariente D, Huault G. Hemodynamic effects of dobutamine in asphyxiated newborn infants [French]. Archives Francaises de Pediatrie 1988;45:467‐70. - PubMed
Feltes 1987
    1. Feltes TF, Hansen TN, Martin CG, Leblanc AL, Smith S, Giesler ME. The effects of dopamine infusion on regional blood flow in newborn lambs. Pediatric Research 1987;21:131‐6. - PubMed
Fiddler 1980
    1. Fiddler GI, Chatrath R, Williams GJ, Walker DR, Scott O. Dopamine infusion for the treatment of myocardial dysfunction associated with a persistent transitional circulation. Archives of Disease in Childhood 1980;55:194‐8. - PMC - PubMed
Goldberg 1988
    1. Goldberg LI. Dopamine and new dopamine analogs: receptors and clinical applications. Journal of Clinical Anesthesia 1988;1:66‐74. - PubMed
Hall 1998
    1. Hall RT, Hall FK, Daily DK. High‐dose phenobarbital therapy in term newborn infants with severe perinatal asphyxia: A randomized, prospective study with three‐year follow‐up. Journal of Pediatrics 1998;132:345‐8. - PubMed
Lou 1977
    1. Lou HC, Lassen NA, Friis‐Hansen B. Low cerebral blood flow in hypotensive perinatal distress. Acta Neurologica Scandinavica 1977;56:343‐52. - PubMed
MacLennan 1999
    1. MacLennan A. A template for defining a causal relation between acute intrapartum events and cerebral palsy: international consensus statement. BMJ 1999;319:1054‐9. - PMC - PubMed
Maggi 1982
    1. Maggi JC, Angelats J, Scott JP. Gangrene in a neonate following dopamine therapy. Journal of Pediatrics 1982;100:323‐5. - PubMed
Martin‐Ancel 1995
    1. Martin‐Ancel A, Garcia‐Alix A, Gaya F, Cabanas F, Burgueros M, Quero J. Multiple organ involvement in perinatal asphyxia. Journal of Pediatrics 1995;127:786‐93. - PubMed
Meek 1999
    1. Meek JH, Elwell CE, McCormick DC, Edwards AD, Townsend JP, Stewart AL, et al. Abnormal cerebral haemodynamics in perinatally asphyxiated neonates related to outcome. Archives of Disease in Childhood 1999;81:F110‐5. - PMC - PubMed
Mizoguchi 1999
    1. Mizoguchi MB, Chu TG, Murphy FM, Willits N, Morse LS. Dopamine use is an indicator for the development of threshold retinopathy of prematurity. British Journal of Ophthalmology 1999;83:425‐8. - PMC - PubMed
Olavarria 1987
    1. Olavarria F, Krause S, Barranco L, Herrmann F, Paez V, Mezzano S, Leal N, Lopez M. Renal function in full‐term newborns following neonatal asphyxia. A prospective study. Clinical Pediatrics 1987;26:334‐8. - PubMed
Padbury 1986
    1. Padbury JF, Agata Y, Baylen BG, Ludlow JK, Polk DH, Goldblatt E, Pescetti J. Dopamine pharmacokinetics in critically ill newborn infants. Journal of Pediatrics 1986;110:293‐8. - PubMed
Padbury 1987
    1. Padbury JF, Agata Y, Baylen BG, Ludlow JK, Polk DH, Goldblatt E, Pescetti J. Dopamine pharmacokinetics in critically ill newborn infants. Journal of Pediatrics 1987;110:293‐8. - PubMed
Primhak 1985
    1. Primhak RA, Jedeikin R, Ellis G, Makela SK, Gillan JE, Swyer PR, Rowe RD. Myocardial ischaemia in asphyxia neonatorum. Acta Paediatrica Scandinavica 1985;74:595‐600. - PubMed
Pryds 1990
    1. Pryds O, Greisen G, Lou H, Friis‐Hansen B. Vasoparalysis associated with brain damage in asphyxiated term infants. Journal of Pediatrics 1990;117:119‐25. - PubMed
Repetto 1999
    1. Repetto JE, Eyal FG, McHargue L, Alpan G. High dose dopamine for the treatment of neonatal hypotension. Pediatric Research 1999;45:221A.
Sarnat 1976
    1. Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress: A clinical and electrographic study. Archives of Neurology 1976;33:696. - PubMed
Seri 1995
    1. Seri I. Cardiovascular, renal, and endocrine actions of dopamine in neonates and children. Journal of Pediatrics 1995;126:333‐44. - PubMed
Seri 1998
    1. Seri I, Abbasi S, Wood DC, Gerdes JS. Regional hemodynamic effects of dopamine in the sick preterm neonate. Journal of Pediatrics 1998;133:728‐34. - PubMed
Thornberg 1995
    1. Thornberg E, Thiringer K, Odeback A, Milsom I. Birth asphyxia: incidence, clinical course and outcome in a Swedish population. Acta Paediatrica 1995;84:927‐32. - PubMed
Tsivyan 1991
    1. Tsivyan PB, Vasenina AD. Left ventricular systolic and diastolic function in term neonates after mild perinatal asphyxia. European Journal of Obstetrics, Gynecology, and Reproductive Biology 1991;40:105‐10. - PubMed
Tyszczuk 1998
    1. Tyszczuk L, Meek J, Elwell C, Wyatt JS. Cerebral blood flow is independent of mean arterial blood pressure in preterm infants undergoing intensive care. Pediatrics 1998;102:337‐41. - PubMed
Van Bel 1990
    1. Bel F, Walther FJ. Myocardial dysfunction and cerebral blood flow velocity following birth asphyxia. Acta Paediatrica Scandinavica 1990;79:756‐62. - PubMed
Venkataraman 1984
    1. Venkataraman PS, Babcock DS, Tsang RC, Ballard JL. Hepatic injury: a possible complication of dopamine infusion through an inappropriately placed umbilical vein catheter. American Journal of Perinatology 1984;1:351‐4. - PubMed
Walther 1985
    1. Walther FJ, Siassi B, Ramadan NA, Wu P. Cardiac output in newborn infants with transient myocardial dysfunction. Journal of Pediatrics 1985;107:781‐5. - PubMed

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