Introduction: The use of epinephrine (EPI) by continuous IV infusion as an inotrope in the term neonate is accepted clinical practice. The efficacy of EPI in animal models has been demonstrated but there remains scant literature on its use in the human neonate. We questioned if continuous IV infusion EPI as an inotrope in ELBW infants improved survival.

Methods: We reviewed the hospital records of all infants ≤ 750g birthweight admitted to our level III NICU during the study period 1/1/1990 to 31/12/1994 inclusive. Severity of illness scoring was performed on all infants using the CRIB (Clinical Risk Index for Babies). Survival data were obtained and the incidence of patent ductus arteriosus (PDA), necrotising enterocolitis (NEC), severe intraventricular hemorrhage (IVH) and periventricular leucomalacia (PVL) was recorded. In the infants on EPI by continuous infusion the maximum dose and duration were noted.

Results: Of 91 infants of ≤ 750g identified during the study period, 47 infants (52%) received IV infusion EPI. There was no significant difference between the two groups in birthweight, gestational age, CRIB score or major complications. Mortality was significantly higher in the EPI group(see Table). Survival to discharge of all infants ≤ 750g birthweight was 35/91 (38.5%), for those who did not require EPI was 25/44 (56%) and for those on IV EPI infusions was 14/47 (21%). No infant who received IV EPI infusion > 1mcg/kg/min survived to discharge.

Table 1
Full size table

Conclusions: 1) Continuous infusion IV EPI is effective as an inotrope in ELBW infants. 2) High dose IV EPI infusion (>1mcg/kg/min) in ELBW infants may be futile.