Use of norepinephrine in preterm neonates with dopamine-resistant shock: a retrospective single-centre cross-sectional study

Abstract

Background: Norepinephrine (NE) is recommended for children and full-term neonates (born at >37 gestational weeks) with septic shock. Meanwhile, data on the effectiveness of NE in preterm neonates are still limited. This study aimed to evaluate the clinical efficacy of NE in preterm neonates with dopamine-resistant shock compared with that in full-term neonates.

Methods: This was a single-centre, retrospective (January 2010-December 2020) cohort study of neonates with persistent shock despite adequate fluid resuscitation and dopamine or dobutamine administration at ≥10 μg/kg/min. Medical records of neonates treated with NE were retrospectively reviewed to collect respiratory and haemodynamic parameters and results of arterial blood gas (ABG) tests before and 8 hours after NE infusion. The effectiveness of NE was assessed using changes in clinical parameters and multiple regression models for mortality among subgroups of preterm and full-term neonates.

Results: Ninety-two neonates (76% preterm) who received NE infusion were included in the study. NE infusion was started after a median of 7 hours (IQR 2-19 hours) after shock onset. Among the preterm neonates, the maximum dose of NE infusion was 0.5 (IQR 0.3-1.0) µg/kg/min with a median duration of 45 (IQR 24.0-84.5) hours. Haemodynamic dysfunction was ameliorated with increased blood pressure, decreased heart rate and improved ABG results. Preterm neonates with septic shock tended to have a reduced response to NE; however, preterm neonates with persistent pulmonary hypertension of the newborn tended to have a better response. Thirty-four (37%) neonates died in our cohort. The timing, dose and duration of NE use were not associated with neonatal mortality.

Conclusions: Although using NE effectively improves clinical parameters in preterm neonates with dopamine-resistant shock, our study is underpowered to identify the association between NE infusion and mortality in preterm neonates with dopamine-resistant shock.

Keywords: Neonatology; Resuscitation.

Figure 1

Locally estimated scatterplot smoothing plot and β coefficient (significant level: *p<0.05, **p<0.01, ***p<0.001) of linear regression models of change in clinical parameters before and 8 hours after NE infusion in neonates with dopamine-resistant shock in all subjects (black), subjects with septic shock (blue) and PPHN (red). ABG, arterial blood gas; FiO₂, fraction of inspired oxygen; MAP, mean airway pressure; MBP, mean blood pressure; NE, norepinephrine; PEEP, positive end-expiratory pressure; PIP, peak inspiratory pressure; PPHN, persistent pulmonary hypertension of the newborn; SBP, systolic blood pressure; SDS, SD score.