Use of norepinephrine in preterm neonates with dopamine-resistant shock: a retrospective single-centre cross-sectional study
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 w...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-12-01
|
| Series: | BMJ Paediatrics Open |
| Online Access: | https://bmjpaedsopen.bmj.com/content/7/1/e001804.full |
| _version_ | 1797368176330145792 |
|---|---|
| author | Yifan Sun Zhiling Li Pei Lu Xiaohui Gong Wenchao Hong |
| author_facet | Yifan Sun Zhiling Li Pei Lu Xiaohui Gong Wenchao Hong |
| author_sort | Yifan Sun |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-08T17:28:54Z |
| format | Article |
| id | doaj.art-9a5b1a523f764e549caa01912b407d53 |
| institution | Directory Open Access Journal |
| issn | 2399-9772 |
| language | English |
| last_indexed | 2024-03-08T17:28:54Z |
| publishDate | 2023-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Paediatrics Open |
| spelling | doaj.art-9a5b1a523f764e549caa01912b407d532024-01-02T16:50:10ZengBMJ Publishing GroupBMJ Paediatrics Open2399-97722023-12-017110.1136/bmjpo-2022-001804Use of norepinephrine in preterm neonates with dopamine-resistant shock: a retrospective single-centre cross-sectional studyYifan Sun0Zhiling Li1Pei Lu2Xiaohui Gong3Wenchao Hong4Department of Neonatology, Shanghai Children`s Hospital, school of medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Pharmacy, Shanghai Children`s Hospital, school of medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Neonatology, Shanghai Children`s Hospital, school of medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Neonatology, Shanghai Children`s Hospital, school of medicine, Shanghai Jiao Tong University, Shanghai, ChinaDepartment of Neonatology, Shanghai Children`s Hospital, school of medicine, Shanghai Jiao Tong University, Shanghai, ChinaBackground 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.https://bmjpaedsopen.bmj.com/content/7/1/e001804.full |
| spellingShingle | Yifan Sun Zhiling Li Pei Lu Xiaohui Gong Wenchao Hong Use of norepinephrine in preterm neonates with dopamine-resistant shock: a retrospective single-centre cross-sectional study BMJ Paediatrics Open |
| title | Use of norepinephrine in preterm neonates with dopamine-resistant shock: a retrospective single-centre cross-sectional study |
| title_full | Use of norepinephrine in preterm neonates with dopamine-resistant shock: a retrospective single-centre cross-sectional study |
| title_fullStr | Use of norepinephrine in preterm neonates with dopamine-resistant shock: a retrospective single-centre cross-sectional study |
| title_full_unstemmed | Use of norepinephrine in preterm neonates with dopamine-resistant shock: a retrospective single-centre cross-sectional study |
| title_short | Use of norepinephrine in preterm neonates with dopamine-resistant shock: a retrospective single-centre cross-sectional study |
| title_sort | use of norepinephrine in preterm neonates with dopamine resistant shock a retrospective single centre cross sectional study |
| url | https://bmjpaedsopen.bmj.com/content/7/1/e001804.full |
| work_keys_str_mv | AT yifansun useofnorepinephrineinpretermneonateswithdopamineresistantshockaretrospectivesinglecentrecrosssectionalstudy AT zhilingli useofnorepinephrineinpretermneonateswithdopamineresistantshockaretrospectivesinglecentrecrosssectionalstudy AT peilu useofnorepinephrineinpretermneonateswithdopamineresistantshockaretrospectivesinglecentrecrosssectionalstudy AT xiaohuigong useofnorepinephrineinpretermneonateswithdopamineresistantshockaretrospectivesinglecentrecrosssectionalstudy AT wenchaohong useofnorepinephrineinpretermneonateswithdopamineresistantshockaretrospectivesinglecentrecrosssectionalstudy |