Dopamine or norepinephrine for sepsis-related hypotension in preterm infants: a retrospective cohort study

被引:4
作者
Nissimov, Sagee [1 ]
Joye, Sebastien [8 ]
Kharrat, Ashraf [1 ,7 ]
Zhu, Faith [1 ,7 ]
Ripstein, Gabriella [9 ]
Baczynski, Michelle [2 ]
Choudhury, Julie [4 ]
Jasani, Bonny [6 ,7 ]
Deshpande, Poorva [1 ,7 ]
Ye, Xiang Y. [3 ]
Weisz, Dany E. [5 ,7 ]
Jain, Amish [1 ,3 ,7 ]
机构
[1] Mt Sinai Hosp, Dept Paediat, Toronto, ON, Canada
[2] Mt Sinai Hosp, Dept Resp Therapy, Toronto, ON, Canada
[3] Mt Sinai Hosp, Lunnenfeld Tanenbaum Res Inst, Toronto, ON, Canada
[4] Sunnybrook Hlth Sci Ctr, Dept Pharm, Toronto, ON, Canada
[5] Sunnybrook Hlth Sci Ctr, Newborn & Dev Paediat, Toronto, ON, Canada
[6] Hosp Sick Children, Dept Pediat, Div Neonatol, Toronto, ON, Canada
[7] Univ Toronto, Dept Paediat, Toronto, ON, Canada
[8] Lausanne Univ Hosp, Clin Neonatol, Lausanne, Switzerland
[9] Univ Toronto, Temerty Fac Med, Toronto, ON, Canada
关键词
Sepsis; Hypotension; Shock; Dopamine; Norepinephrine; Vasopressors; Preterm infant; CAMPAIGN INTERNATIONAL GUIDELINES; SEPTIC SHOCK; EPINEPHRINE; TRIAL; DYSFUNCTION; MANAGEMENT; PRESSURE;
D O I
10.1007/s00431-022-04758-4
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
The purpose of this study is to compare the clinical effectiveness of dopamine (DA) versus norepinephrine (NE) as first-line therapy for sepsis-related hypotension in preterm infants. This is a retrospective cohort study over 10 years at two tertiary neonatal units. Preterm infants born < 35 weeks post-menstrual age (PMA), who received DA or NE as primary therapy for hypotension during sepsis, defined as culture-positive or culture-negative infections or necrotizing enterocolitis (NEC), were included. Episode-related mortality (< 7 days from treatment), pre-discharge mortality, and major morbidities among survivors were compared between two groups. Analyses were adjusted using the inverse probability of treatment weighting estimated by propensity score (PS). A total of 156 infants were included, 113 received DA and 43 NE. The mean +/- SD PMA at birth and at treatment for the DA and NE groups were 25.8 +/- 2.3 vs. 25.2 +/- 2.0 weeks and 27.7 +/- 3.0 vs. 27.1 +/- 2.6 weeks, respectively (p > 0.05). Pre-treatment, the NE group had higher mean airway pressure (14 +/- 4 vs. 12 +/- 4 cmH(2)O), heart rate (185 +/- 17 vs. 175 +/- 17 beats per minute), and median (IQR) fraction of inspired oxygen [0.67 (0.42, 1.0) vs. 0.52 (0.32, 0.82)] (p < 0.05 for all). After PS adjustment, NE was associated with lower episode-related mortality [adjusted odds ratio (95% CI) 0.55 (0.33, 0.92)], pre-discharge mortality [0.60 (0.37, 0.97)], post-illness new diagnosis of significant neurologic injury [0.32 (0.13, 0.82)], and subsequent occurrence of NEC/sepsis among the survivors [0.34, (0.18, 0.65)].Conclusion: NE may be more effective than DA for management of sepsis-related hypotension among preterm infants. These data provide a rationale for prospective evaluation of these commonly used agents.
引用
收藏
页码:1029 / 1038
页数:10
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