Abstract
The aetiology of hypotenaion in the VLBW infant remains unclear. Present management normally involves awaiting a response to volume expansion before using cardiac inotropes. A recent echocardiography study suggested that myocardial dysfunction was a significant feature in such infants [1]. This study was to test the hypothesis that Dopamine (to a maximum of 10 ug/kg/min) was more effective than PPF (to a maximum of 40 mls/kg) in restoring and maintaining the BP at or above the 10th centile for the VLBW infant.
39 infants were enrolled, median birthweight 878 grams (range 599-1452) and gestation 27 weeks (range 23-31). 20 received PPF and 19 Dopamine, as first line therapy, if their MEAN BP fell to < 10th centile.
Of the PPF group, 11/20 (55%) required treatment with Dopamine, whereas of the Dopamine group, only 2/19 (11%) required treatment with PPF before the BP recovered, Chi-squared= 6.9, p=0.009. The median dose of Dopamine required was 7.5 ug/kg/min and infused for a median duration of 18 hours (range 6-30). Neonatal complications were not altered by the use of dopamine alone.
Conclusion: Dopamine appeared to bo more effective than PPF and should be considered at the outset in the management of the hypotensive VLBW infant.
[1] Gill A.B. Weindling A.M. Arch Dis Child 1993; 68: 17-21.
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Gill, B., Weindling, M. Randomised controlled trial to compare plasma protein fraction (PPF) and Dopamine in the hypotensive vary low birthweight (VLBW) Infant. Pediatr Res 35, 273 (1994). https://doi.org/10.1203/00006450-199402000-00111
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DOI: https://doi.org/10.1203/00006450-199402000-00111