Intervention Review

Dopamine for prevention of morbidity and mortality in term newborn infants with suspected perinatal asphyxia

  1. Rod Hunt1,*,
  2. David A Osborn2

Editorial Group: Cochrane Neonatal Group

Published Online: 22 JUL 2002

Assessed as up-to-date: 26 MAR 2002

DOI: 10.1002/14651858.CD003484


How to Cite

Hunt R, Osborn DA. Dopamine for prevention of morbidity and mortality in term newborn infants with suspected perinatal asphyxia. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD003484. DOI: 10.1002/14651858.CD003484.

Author Information

  1. 1

    Royal Children's Hospitals, Melbourne, Department of Neonatal Medicine, Parkville, Melbourne, Victoria, Australia

  2. 2

    Royal Prince Alfred Hospital, RPA Newborn Care, Camperdown, New South Wales, Australia

*Rod Hunt, Department of Neonatal Medicine, Royal Children's Hospitals, Melbourne, Level 2, Royal Children's Hospital, Flemington Road, Parkville, Melbourne, Victoria, 3052, Australia. rod.hunt@rch.org.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 22 JUL 2002

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Perinatal asphyxia remains an important condition with significant mortality and long-term morbidity. Multisystem involvement including hypotension and low cardiac output is common in infants with perinatal asphyxia. Dopamine is commonly used for infants with hypotension of any etiology, with the goal of improving cardiac output and preventing its detrimental consequences.

Objectives

To determine if dopamine, compared to placebo, no treatment, volume or another inotrope reduces morbidity and mortality in term newborn infants with suspected perinatal asphyxia.

Search methods

The standard search strategy of the Neonatal Review Group was used. Searches were conducted of the Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2002), MEDLINE (1966 to March 2002), previous reviews including cross references, abstracts and conference proceedings (Perinatal Society of Australia and New Zealand 1998-2002 and Pediatric Academic Societies meetings 1998-2001).

Selection criteria

Randomised controlled trials comparing dopamine with placebo, no treatment, other inotropic agents, or volume in infants greater than 36 weeks gestation. Perinatal asphyxia could be suspected on the basis of a cord blood pH < 7.0, cord blood base excess < -16 mEq/L or 5 minute Apgar score < 6.

Data collection and analysis

Standard methods of the Cochrane Neonatal Review Group with use of relative risk (RR), risk difference (RD) and weighted mean difference (WMD). The fixed effects model using RevMan 4.1 was used for meta-analysis. Data from individual studies were only eligible for inclusion if at least 75% of participants were followed up.

Main results

Only one study (DiSessa 1981) was eligible. This study compared low dose dopamine at 2.5 mcg/kg/min with placebo (dextrose in water). This study enrolled 14 term infants with a 5 minute Apgar <6 and a systolic BP >=50 mmHg at a mean of 10 hours age. Seven infants only were randomised to treatment with dopamine and seven to receive placebo. No significant differences between these two groups were found for mortality or long term neurodevelopmental outcome. Length of hospitalisation was not significantly different between the two groups. No study was found that examined the effect of dopamine in infants with evidence of cardiovascular compromise, nor were any studies identified in which dopamine was compared to other inotropic agents for term infants with suspected asphyxia.

Authors' conclusions

There is currently insufficient evidence from randomised controlled trials that the use of dopamine in term infants with suspected perinatal asphyxia improves mortality or long-term neurodevelopmental outcome. The question of whether dopamine improves outcome for term infants with suspected perinatal asphyxia has not been answered. Further research is required to determine whether or not the use of dopamine improves mortality and long-term morbidity for these infants and if so, issues such as which infants, at what dose and with what co-interventions should be addressed.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Dopamine for prevention of morbidity and mortality in term newborn infants with suspected perinatal asphyxia

Dopamine to improve outcomes in newborn infants with a suspected lack of oxygen during birth. A lack of oxygen around the time of birth (perinatal asphyxia) can cause death and long-term illness in newborn infants. It is indicated by a low Apgar score five minutes after birth and acidic umbilical cord blood (acidosis). An infant experiencing asphyxia may need urgent resuscitation, oxygen and supported breathing (assisted ventilation). Often they have low blood pressure and poor heart function. The drug dopamine stimulates the heart and is used to improve blood flow to the brain and other organs to reduce brain and other organ damage. Possible adverse events from giving such an agent include damage with the umbilical venous catheter and heart irregularities (arrhythmias). The review authors searched the medical literature and were able to find only one small randomised controlled trial. The 14 infants included in the trial had a birthweight over 2000 g and were enrolled at a mean age of 10 hours. They had received ventilatory support and fluid expansion after birth. Infants treated with low dose dopamine (2.5 microg/kg/min) did not differ from the infants receiving placebo (dextrose water) in the number who died before discharge from hospital. Neurodevelopmental disability was similar in both groups, in all infants randomised and in survivors. The timing of assessments was variable. These findings are limited with only one small study in which three of 12 survivors were lost to follow up.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

以多巴胺來預防疑有週產期窒息之足月新生兒的罹病率和死亡率

週產期窒息仍然是一個影響死亡率和長期罹病率的重要條件。罹患週產期窒息的嬰兒通常有多重器官受到影響,其中包括了低血壓及低心輸出量。多巴胺常用於嬰幼兒因各種原因造成的低血壓,並改善因低心輸出量而造成的有害影響。

目標

在疑似罹患週產期窒息的足月兒中,比較有多巴胺治療與安慰劑給予,在沒有任何藥物、輸液治療或強心劑使用下,是否可降低罹病率及死亡率。

搜尋策略

使用新生兒評價組的標準策略進行檢索。包括檢索了以下電子數據庫:牛津周產期試驗數據庫;Cochrane對照試驗註冊資料庫(Cochrane圖書館,2002年第1期);MEDLINE(1966年-2002年3月)以及含參考文獻的回顧綜述,摘要、會議與研討會論文集。(Perinatal Society of Australia and New Zealand 1998 – 2002and Pediatric Academic Societies meetings 1998 – 2001)。

選擇標準

在妊娠大於36週的嬰兒,當臍血pH值< 7.0,臍血過鹼< −16 meq/L或5分鐘Apgar score <6,即被懷疑可能發生週產期窒息,並未接受其他藥物、輸液及強心劑治療下,隨機取樣來比較多巴胺與安慰劑的治療效果。

資料收集與分析

採用Cochrane Neonatal Review Group的標準方法針對相對的危險性(RR)、風險差異性(RD)和 加權均數差(WMD)來進行評估。使用固定模式Rev Man 4.1的計算方式。數據經由個別的研究收集而成,條件是包括至少有75%的案例持續進行追蹤研究。

主要結論

只有一個研究報告符合資格(DiSessa 1981)。這項研究比較低劑量多巴胺在2.5mcg/kg/min與安慰劑(葡萄糖水)的差異性。本研究紀錄14位5分鐘Apgar score小於6和收縮壓大於或等於50毫米汞柱;年齡平均在出生後10個小時的嬰兒,由其中隨機取樣7名嬰幼兒接受多巴胺治療,另外7名則接受安慰劑。兩組間的死亡率或長期神經發展的結果並無顯著差異。住院天數在兩組間亦無顯著差異。沒有研究報告顯示多巴胺在嬰幼兒的有緩和心血管症狀的效果。也沒有任何研究報告顯示多巴胺與其他強心劑相比對週產期窒息有較顯著的療效。

作者結論

目前根據隨機取樣試驗所比較出的結果並不足以證明足月兒在懷疑有週產期窒息時使用多巴胺可以改善死亡率或長期神經發展的結果。至於多巴胺是否能改善懷疑有週產期窒息的足月兒的成果仍未定論。如此,是否使用多巴胺來改善這些疑似患有週產期窒息的嬰幼兒罹病率和長期神經發展則需要繼續更進一步的研究;如哪些條件的嬰兒,在什麼劑量和甚麼藥物的合併使用下可以得到緩解。

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

多巴胺被用以改善,懷疑在出生時缺氧的新生兒。新生兒在出生時缺氧(週產期窒息),可能導致死亡和長期的疾病。由出生後5分鐘之低Apgar score和臍血酸化(酸中毒)來表現。嬰兒發生窒息時,可能需要緊急復甦,氧氣和支持性呼吸(輔助通氣)。他們往往有低血壓和不好的心臟功能。多巴胺是用來刺激心臟,並改善到腦部和其他器官的血流,以減少腦和其它器官損害。但給予後可能帶來的副作用,包括臍靜脈導管引起的損害和心跳異常(心律失常)。作者群搜查醫學文獻,只能找到有一個小的隨機對照試驗,這其中的14個嬰兒,出生體重超過2000公克,在平均年齡為10小時分組。他們在出生後便接受輔助通氣和液體輸注。出院前死亡的嬰兒在使用低劑量多巴胺(2.5 微克/公斤/分鐘),與接受安慰劑(葡萄糖水)治療的效果並無不同。在所有隨機取樣的嬰兒和在倖存者中,兩組的神經發育障礙也類似。評估的時間是不定的。這些研究結果是有限的,因為只有一個小研究,而且12個生還者中有3個之後沒有回診追蹤。