Association between dopamine and cerebral autoregulation in preterm neonates

Abstract

Background: To test the hypothesis that dopamine is associated with impaired cerebral autoregulation (ICA) in a dose-dependent fashion.

Methods: Non a priori designed secondary analysis of a prospectively enrolled cohort study subjects <12 h of life between 24⁰ and 29⁶ weeks gestation. Cerebral saturations (rScO2) and mean arterial blood pressure (MAP) were continuously monitored every 30 s for 96 h. ICA was defined by a 10 min epoch rScO2-MAP correlation coefficient of >0.5.

Results: Twenty-three of 61 subjects (38%) required dopamine. Time spent with ICA was 23% in dopamine-exposed subjects vs. 14% in those not exposed (p = 0.0001). On the epoch level, time spent with ICA was 15%, 29%, 34%, 37%, and 23% in epochs with dopamine titration of 0, 1-5, 6-10, 11-15, and 16-20 μg/kg/min, respectively. Using mixed-effect modeling, ICA for each dopamine titration was significantly higher than unexposed times when controlling for gestation, presence of a patent ductus arteriosus, day of life, MAP less than gestational age, and illness severity score (p < 0.02).

Conclusions: Dopamine exposure during the first 96 h was associated with ICA. Time periods with ICA increased with dopamine exposure in a dose-dependent fashion peaking at a concentration of 11-15 μg/kg/min.

Fig. 1

Median (black box) and range of dopamine titrations by subject during the monitoring period.

Fig. 2. Percent time spent with mean arterial blood pressure less than gestational age by dopamine titration.

*p < 0.05 when compared to the no dopamine titration group.

Fig. 3. Percent time spent with impaired cerebral autoregulation by dopamine titration.

*p < 0.0001 when compared to no dopamine, **p = 0.03 compared with no dopamine, and ^†p = 0.003 when compared to the 1 to 5 titration, ^ǂp < 0.0001 when compared to the 11 to 15 titration; all p values are based on mixed modeling adjusted for day of life, GA, MAP less than GA, PDA status, and SNAPPE-II score.