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Response to dopamine in prematurity: a biomarker for brain injury?

Journal of Perinatology volume 36, pages 453–458 (2016)Cite this article

Subjects

An Erratum to this article was published on 25 April 2016

Abstract

Objective:

To identify factors associated with responsiveness to dopamine therapy for hypotension and the relationship to brain injury in a cohort of preterm infants.

Study Design:

The pharmacy database at St Louis Children’s Hospital was retrospectively queried to identify infants who (a) were born <28 weeks gestation between 2012 and 2014, (b) received dopamine and (c) had blood pressure measurements from an umbilical arterial catheter. A control group was constructed from contemporaneous infants who did not receive dopamine. Mean arterial blood pressure (MABP) at baseline, 1 h and 3 h after initiating dopamine were obtained for each dopamine-exposed infant. MABP measurements at matched time points were obtained in the control group.

Result:

Sixty-nine dopamine-treated and 45 control infants were included. Mean ΔMABP at 3 h was 4.5±6.3 mm of Hg for treated infants vs 1±2.9 for the control. Median dopamine starting dose was 2.5 μg kg−1 min−1. Dopamine-treated infants were less mature and of lower birth weight while also more likely to be intubated at 72 h, diagnosed with intraventricular hemorrhage (IVH) and to die. Failure to respond to dopamine was associated with greater likelihood of developing IVH (odds ratio (OR) 5.8, 95% confidence interval (CI) 1.1–42.3), while a strong response (ΔMABP>10 mm Hg) was associated with a reduction in risk of IVH (OR 0.1, 95% CI 0.01–0.8).

Conclusion:

Low–moderate dose dopamine administration results in modest blood pressure improvements. A lack of response to dopamine is associated with a greater risk of IVH, whereas a strong response is associated with a decreased risk. Further research into underlying mechanisms and management strategies is needed.

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Acknowledgements

We thank Brandy Zeller, PharmD and Caren Livisky, PharmD for their assistance in identifying infants using the pharmacy database system and Anthony Barton for his tireless efforts in recruitment and data management. This study was supported by Intellectual and Developmental Disabilities Research Center (IDDRC) at Washington University (NIH/NICHD P30 HD062171), Washington University Institute of Clinical and Translational Sciences KL2 Training Program (NIH/NCATS KL2 TR000450) and The Barnes-Jewish Hospital Foundation and the Washington University Institute of Clinical and Translational Sciences Clinical and Translational Funding Program (NIH/NCATS UL1 TR000448).

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Authors and Affiliations

  1. Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA

    Z A Vesoulis, N E Ters, A Foster, S B Trivedi, S M Liao & A M Mathur

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  1. Z A Vesoulis
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  2. N E Ters
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  3. A Foster
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  4. S B Trivedi
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  5. S M Liao
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Correspondence to Z A Vesoulis.

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Vesoulis, Z., Ters, N., Foster, A. et al. Response to dopamine in prematurity: a biomarker for brain injury?. J Perinatol 36, 453–458 (2016). https://doi.org/10.1038/jp.2016.5

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