Get access

Dopamine versus no treatment to prevent renal dysfunction in indomethacin-treated preterm newborn infants

  • Review
  • Intervention

Authors


Abstract

Background

Indomethacin therapy for closure of patent ductus arteriosus (PDA) frequently causes oliguria and occasionally more serious renal dysfunction. Low dose dopamine has been suggested as a means for preventing this side effect.

Objectives

To determine whether dopamine therapy prevents indomethacin-mediated deterioration in renal function in the preterm newborn infant without serious adverse effects. Subgroup analyses were planned to assess the effects of dopamine on patients given indomethacin as prophylaxis of intraventricular hemorrhage, and patients given indomethacin as treatment of PDA.

Search methods

Standard methods of the Cochrane Neonatal Review Group (CNRG) were used. We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2009), MEDLINE (1966 to 2009), EMBASE (1974 to 2009) and CINAHL (2001 to 2009). In addition, we contacted the principal investigators if necessary to ascertain required information.

Selection criteria

Randomized or quasi-randomized studies of the effects of dopamine on urine output, glomerular filtration rate, fluid balance or incidence of renal failure, in preterm newborn infants receiving indomethacin. The comparison group should have received no dopamine.

Data collection and analysis

We used the standard methods of the Cochrane Collaboration and those of the CNRG. For categorical outcomes, we calculated typical estimates for relative risk and risk difference. For continuous outcomes the weighted mean difference (WMD) was calculated. Fixed effect models were assumed for meta-analysis.

Main results

Three studies were found (total number randomized patients 75) that fulfilled the entry criteria for this review. All were single center trials that enrolled NICU patients receiving indomethacin for symptomatic PDA. There are no (or only partial) results for effects of dopamine on several of the primary outcomes, including death before discharge, serious intraventricular hemorrhage, cystic periventricular leukomalacia, or renal failure. There has been inadequate investigation of the effects of dopamine on cerebral perfusion or cardiac output, or GI complications, or endocrine toxicity. Dopamine improved urine output [WMD 0.68 ml/kg/hour (95% CI 0.22, 1.44)], but there was no evidence of effect on serum creatinine (WMD 2.04 micromoles/liter, CI -17.90, 21.97) or the incidence of oliguria (urine output < 1 ml/kg/hour) (RR 0.73, CI 0.35, 1.54). There was no evidence of effect of dopamine on the frequency of failure to close the ductus arteriosus (RR 1.11, CI 0.56, 2.19).

Authors' conclusions

There is no evidence from randomized trials to support the use of dopamine to prevent renal dysfunction in indomethacin-treated preterm infants.

摘要

背景

比較多巴胺(dopamine)的使用與否,對於預防早產兒因使用indomethacin所引起的腎功能不全

Indomethacin治療動脈導管閉鎖不全經常發生貧尿,有時更造成嚴重的腎功能不全。已有建議使用低劑量多巴胺來防止這種副作用。

目標

主要目標:確定多巴胺是否可預防早產兒使用indomethacin治療時引起的腎功能惡化,以及沒有造成嚴重的副作用。 次要目標:評估多巴胺在兩組變異組的作用:(1)患者給予indomethacin作為預防腦室內出血,(2)患者給予indomethacin作為治療動脈導管閉鎖不全。

搜尋策略

採用Cochrane Neonatal Review Group的標準方法(CNRG)。搜尋Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 3, 2009)、MEDLINE (1966 to 2009)、EMBASE (1974 to 2009)及CINAHL (2001 to 2009) 。此外若有需要,作者則與主要的研究員聯繫以確認所需資料。

選擇標準

在接受indomethacin治療的早產兒中隨機或半隨機取樣來研究多巴胺對尿量,腎小球濾過率,液體平衡或發生腎功能衰竭的影響。對照組則未接受多巴胺。

資料收集與分析

採用Cochrane Neonatal Review Group的標準方法。統計的內容包括:出院前的死亡率 三級或四級的腦室內出血 囊性腦室周圍白質軟化症腎功能衰竭(貧尿,界定為尿量少於1毫升/公斤/小時或肌酐酸40 微克分子/升 以上) 需要外科手術的動脈導管閉鎖不全。對於分類性的結果數據,作者使用相對風險和風險差異做計算評估。對於連續性的結果數據採用weighted mean difference分析。綜合資料分析假定為Fixed effect models。

主要結論

有三項研究(隨機患者總數:75位)是符合這篇回顧的加入標準,三項都是單一中心的實驗,全數是新生兒加護中心接受indomethacin治療有症狀的存開性動脈導管的病人。只有部分或幾乎沒有報告證實多巴胺對某些主要結果的影響,包括出院前死亡,嚴重腦室內出血,囊性腦室周圍白質軟化或腎功能衰竭。調查的結果,對多巴胺在腦灌注或心輸出量,胃腸併發症,或內分泌毒性的影響 ,都有不足。多巴胺可改善尿排出量[WMD 0.68 毫升/公斤/小時(95 % CI為0.22 , 1.44)],但沒有任何影響血肌酐的證據(WMD 2.04 微克分子/升,CI −17.90 , 21.97)或發生乏尿(尿量<1毫升/公斤/小時) (RR 0.73 ,CI 0.35 , 1.54) 。目前還沒有任何證據顯示多巴胺對關閉失敗的動脈導管頻率的影響(RR 1.11 ,CI 0.56 , 2.19) 。

作者結論

目前從隨機對照臨床試驗中,並無證據支持使用多巴胺,可以預防早產兒因使用indomethacin引起的腎功能不全。

翻譯人

本摘要由臺中榮民總醫院王瑩翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

比較多巴胺(dopamine)的使用與否,對於預防早產兒因使用indomethacin所引起的腎功能不全:多巴胺並沒有被證明有助於預防indomethacin對早產兒腎臟的不利影響。Indomethacin常被用在早產兒身上,以防止腦出血或促進動脈導管的關閉(開放性動脈導管—是一條介於肺部和心臟之間在出生後應關閉而未關閉的通道)。Indomethacin經常引起液體瀦留,並減少尿流量,偶有造成腎功能惡化。因此多巴胺有時候與indomethacin 並用,以防止腎臟產生不良影響。本回顧發現,仍沒有足夠的證據顯示,給予多巴胺在以indomethacin治療的嬰兒身上有任何的價值。

Plain language summary

Dopamine versus no treatment to prevent renal dysfunction in indomethacin-treated preterm newborn infants

Dopamine has not been shown to prevent adverse effects of indomethacin on the kidneys of preterm babies. Indomethacin is a drug used in preterm babies to prevent brain hemorrhage or to help close off PDA (patent ductus arteriosus - when a channel between the lungs and heart does not close off after birth as it should). Indomethacin often causes fluid retention and reduced flow of urine, which can sometimes cause deterioration in kidney (renal) function. The drug dopamine is sometimes used along with indomethacin to try and prevent negative impact on the kidneys. The review found there is not enough evidence from trials to show there is any value in giving dopamine to babies being treated with indomethacin.

Laički sažetak

Dopamin u usporedbi s nikakvim liječenjem za spriječavanje poremećaja funkcije bubrega kod prijevremeno rođene dojenčadi liječene indometacinom

Nije se pokazalo da dopamin spriječava štetne učinke indometacina na bubrege kod prijevremeno rođene djece. Indometacin je lijek koji se koristi u prijevremeno rođene djece za spriječavanje krvarenja u mozgu ili kao pomoć u zatvaranju otvorenog arterijskog duktusa (kada se kanal između pluća i srca ne zatvori nakon rođenja kao što bi trebao). Indometacin često uzrokuje zadržavanje tekućine i smanjeno mokrenje, što ponekad može uzrokovati pogoršanje bubrežne funkcije. Lijek dopamin se ponekad koristi uz indometacin kako bi se pokušalo spriječiti negativan utjecaja na bubrege. Ovaj Cochrane sustavni pregled je pronašao da nema dovoljno dokaza iz istraživanja koji bi pokazali postoji li neka korist od davanja dopamina djeci liječenoj indometacinom.

Bilješke prijevoda

Cochrane Hrvatska
Prevela: Katarina Vučić
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr

Laienverständliche Zusammenfassung

Vergleich zwischen Dopamin und keiner Behandlung zur Vorbeugung von Nierenfunktionsstörungen bei Frühchen, die mit Indomethacin behandelt werden

Bisher konnte nicht gezeigt werden, dass Dopamin die unerwünschten Wirkungen einer Behandlung mit Indomethacin auf die Nieren von Frühchen vorbeugt. Indomethacin ist ein Medikament, was bei Frühchen eingesetzt wird, um eine Hirnblutung zu verhindern oder die Schließung eines offenen Duktus arteriosus zu fördern. Der Duktus arteriosus ist eine Verbindung zwischen Lunge und Herzen, die manchmal nach der Geburt offen bleibt, statt sich zu verschließen. Indomethacin verursacht häufig Wasseransammlungen im Körper und verringert die Harnproduktion, was die Nierenfunktion schädigen kann. Das Medikament Dopamin wird manchmal zusammen mit Indomethacin eingesetzt, um die unerwünschten Wirkungen auf die Nieren vorzubeugen. Dieser Review zeigt, dass es nicht genügend Evidenz gibt, dass die Gabe von Dopamin bei Säuglingen, die mit Indomethacin behandelt werden, sinnvoll ist.

Anmerkungen zur Übersetzung

Koordination durch Cochrane Schweiz

Ancillary