Randomised trial of dopamine compared with hydrocortisone for the treatment of hypotensive very low birthweight infants

Bourchier, D; Weston, Philip J.

doi:10.1136/fn.76.3.f174

Cited by 124 publications

(82 citation statements)

References 37 publications

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“…Additionally, only two of the six studies mentioned are able to characterize the early (hours) response to HC. 5,13 In the present study there was a documented improvement in arterial pressure by 2 h that was sustained at 6, 12 and 24 h after administration of HC (Figure 2).…”

Section: Discussionsupporting

confidence: 66%

“…11,12 While the standard therapy for hypotension has included volume expansion with colloid or crystalloid and the administration of inotropic agents, glucocorticoids have been used successfully in patients with cardiovascular compromise related to adrenal dysfunction. 5,6,11,[13][14][15][16] Because of concerns over short-and longterm side effects with dexamethasone, [17][18][19] hydrocortisone (HC) has been used as an alternative glucocorticoid. 20 However, HC treatment has been recently associated with spontaneous intestinal perforation (SIP).…”

Section: Introductionmentioning

confidence: 99%

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Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns

et al. 2008

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Objective: The purpose of this observation was to evaluate the safety and efficacy of hydrocortisone (HC) for the treatment of refractory hypotension in term and preterm infants. A secondary purpose was to determine the utility of serum cortisol concentrations in predicting the response to treatment.Study Design: This is a retrospective observational study of 117 infants treated with a standardized HC protocol for refractory hypotension. Refractory hypotension was defined as a mean arterial pressure (MAP) less than the gestational age (GA) despite a total inotrope dose of 20 mg per kg per min. Baseline serum cortisol concentrations were determined prior to treatment with stress dose HC.Result: Treatment with HC increased the MAP at 2, 6, 12 and 24 h after initiation, decreased the total inotrope dose at 6, 12 and 24 h, and was associated with resolution of oliguria. There was no correlation between the pretreatment baseline cortisol concentration and GA, birth weight or the response to treatment. The incidence of grades III to IV intraventricular hemorrhage, periventricular leukomalacia, bacterial or fungal sepsis and spontaneous intestinal perforation (SIP) after HC treatment was similar to institutional historic controls prior to institution of this standardized HC protocol.Conclusion: HC treatment was associated with a rapid resolution of cardiovascular compromise. The incidence of significant side effects was similar to that in previously published reports, including a comparable incidence of SIP. On the basis of our results, measuring baseline serum cortisol concentration to guide the management of refractory hypotension is unwarranted.

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Section: Discussionsupporting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns

et al. 2008

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“…4,8,9,13,18 -39 For studies using a case-control design or random assignment to therapy for hypotension, sample sizes and associated effect size estimates of the efficacy of dopamine therapy for increasing blood pressure in comparison with epinephrine, dobutamine, hydrocortisone, colloid or no therapy are presented in Table 2. 4,9,13,17,18,21,22,[24][25][26]28,29,31 Sample sizes and associated effect size estimates for studies examining CBF are presented in Table 3. 8,9,18,25,29,36,37,40 Sample sizes and associated effect size estimates for studies examining adverse neurologic outcome are presented in Table 4.…”

Section: Resultsmentioning

confidence: 99%

A meta-analysis of dopamine use in hypotensive preterm infants: blood pressure and cerebral hemodynamics

2011

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Objective: Dopamine administration results in variable effects on blood pressure in hypotensive preterm infants. The clinical benefits of dopamine administration in increasing cerebral blood flow (CBF) and reducing adverse neurological outcomes in hypotensive preterm neonates are unclear. The objective of this study was to examine the efficacy of dopamine for treatment of hypotension and investigate the changes in cerebral hemodynamics and central nervous system injury in hypotensive preterm infants following dopamine administration.Study Design: Standard meta-analytic techniques, including random and fixed effects models, were used to calculate combined effect size correlations and significance levels.Result: Random effects meta-analysis found that dopamine increases mean arterial blood pressure (12 studies; N ¼ 163; r ¼ 0.88, 95% confidence interval (CI) ¼ 0.76 to 0.94) and systolic blood pressure (8 studies; N ¼ 142; r ¼ 0.81, 95% CI ¼ 0.42 to 0.94). For the increase in blood pressure, dopamine administration was associated with a significantly greater overall efficacy than dobutamine (seven studies; N ¼ 251; r ¼ 0.26; 95% CI ¼ 0.20 to 0.32), colloid (two studies; N ¼ 67; r ¼ 0.60; 95% CI ¼ 0.41 to 0.74) and hydrocortisone (one study; N ¼ 28; r ¼ 0.40; 95% CI ¼ 0.034 to 0.67). CBF increased following dopamine administration (five studies; N ¼ 75; r ¼ 0.36; 95% CI ¼ À0.059 to 0.67) and the increase in CBF was greater in hypotensive than normotensive preterm infants (eight studies; N ¼ 153; r ¼ 0.16; 95% CI ¼ À0.0080 to 0.32). There were no statistically significant differences in adverse neurological outcome between dopamine and dobutamine (three studies; N ¼ 118; r ¼ À0.13; 95% CI ¼ À0.31 to 0.059), epinephrine (two studies; N ¼ 46; r ¼ 0.06; 95% CI ¼ À0.23 to 0.34), colloid (two studies; N ¼ 80; r ¼ 0.0070; 95% CI ¼ À0.218 to 0.23) or hydrocortisone administration (one study; N ¼ 40; r ¼ À0.10; 95% CI ¼ À0.40 to 0.22).Conclusion: Dopamine administration increases mean and systolic blood pressure in hypotensive preterm infants, and is more effective than dobutamine, colloid or hydrocortisone alone. Dopamine administration is associated with increased CBF, with greater increases in CBF in hypotensive than in normotensive preterm infants. Dopamine is not associated with a greater incidence of adverse effects than other therapies used to treat hypotension.

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“…Heckmann et al 34 found a difference in cortisol levels between hypotensive and well preterm infants; however, the authors were unable to show any relationship between response to steroids and cortisol level among hypotensive infants. Bourchier et al 35 concluded that basal cortisol levels did not predict success of treatment with HC. Other investigators have not observed a correlation between baseline cortisol levels and the development of chronic lung disease, 8,36 and between severity of illness and cortisol levels.…”

Section: Discussionmentioning

confidence: 99%

A Randomized-Controlled Trial of Prophylactic Hydrocortisone Supplementation for the Prevention of Hypotension in Extremely Low Birth Weight Infants

Efird

Heerens²,

Gordon

et al. 2004

J Perinatol

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Extremely low birth weight (ELBW) infants are at risk for hypotension. Abnormal adrenal function may play a role in the pathogenesis of hypotension, and therefore, the administration of hydrocortisone (HC) may be an effective treatment for hypotension in some infants. However, the efficacy of prophylactic HC to prevent the use of vasopressors for a defined hypotensive state has not been studied. We conducted a randomized-controlled trial to determine the potential role on adrenal insufficiency in early neonatal hypotension and to determine the effectiveness of prophylactic HC in reducing treatment of hypotension in ELBW infants. STUDY DESIGN:Infants were assigned to receive either HC or placebo within the first 3 hours of life. Therapy was continued for 5 days. The presence of hypotension was based on an operational definition and treatment with vasopressors (VP) was standardized based on an a priori protocol. RESULTS:A total of 34 patients were enrolled. Baseline characteristics were similar between groups. Of the HC group 25% received VP at 24 hours of age compared to 44% of the placebo group. On day of life 2, only 7% of the HC group received VP compared to 39% of the placebo group (p<0.05). CONCLUSION:Prophylactic treatment with HC reduces the incidence of hypotension, defined by treatment with VP, among ELBW infants during the first 2 days of life. However, the mounting evidence that prophylactic administration of glucocorticoids in the first days of life is harmful to ELBW infants makes HC prophylaxis unwise until the efficacy of treatment relative to safety can be clearly established.

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Randomised trial of dopamine compared with hydrocortisone for the treatment of hypotensive very low birthweight infants

Cited by 124 publications

References 37 publications

Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns

Hydrocortisone administration for the treatment of refractory hypotension in critically ill newborns

A meta-analysis of dopamine use in hypotensive preterm infants: blood pressure and cerebral hemodynamics

A Randomized-Controlled Trial of Prophylactic Hydrocortisone Supplementation for the Prevention of Hypotension in Extremely Low Birth Weight Infants

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