Noradrenaline for management of septic shock refractory to fluid loading and dopamine or dobutamine in full-term newborn infants

Aim: To determine the effects of noradrenaline in full-term newborns with refractory septic shock. Methods: Newborns of >35 weeks' gestation with persistent septic shock, despite adequate fluid resuscitation and high dose of dopamine/dobutamine were eligible. In this prospective observational study, we recorded respiratory and hemodynamic parameters prior to and 3 h after starting noradrenaline infusion. Results: Twenty-two newborns were included (gestational age [GA] 39 +/- 1.7 weeks, birth weight (BW) 3110 +/- 780 g). Before starting noradrenaline, the infants received a mean volume expansion of 31 +/- 15 mL/kg and a mean infusion rate of dopamine of 14 +/- 5 mu g/kg/min or dobutamine of 12 +/- 6 mu g/kg/min. Three hours after starting noradrenaline (rate 0.5 +/- 0.4 mu g/kg/min), the mean arterial blood pressure rose from 36 +/- 5 to 51 +/- 7 mmHg (p < 0.001). Urine output increased from 1 +/- 0.5 to 1.7 +/- 0.4 mL/kg/h (p < 0.05). Blood lactate concentration decreased from 4.8 +/- 2.3 to 3.3 +/- 1.8 mmol/L (p < 0.01). Despite an initial correction of hypotension, four infants died later. Conclusion: Noradrenaline was effective in increasing systemic blood pressure. An increase in urine output and a decrease in blood lactate concentration suggest that noradrenaline may have improved cardiac function and tissue perfusion.