Article Text

  1. S. D. Duncan1,
  2. B. N. Payne1
  1. 1Department of Pediatrics, University of Louisville, Louisville, KY


Treatments for hypotensive preterm infants include volume expansion, inotropic agents, and corticosteroids. Common inotropic agents include dopamine, dobutamine, and epinephrine. There are few studies describing the effects and efficacy of inotropes, particularly in terms of survival. This paucity of information led to the hypothesis that in infants ≤ 1,500 g or ≤ 32 weeks' gestation receiving inotropic support, there will be no difference in mortality when epinephrine is added as an adjunctive inotropic agent. A retrospective chart review of patients admitted to Kosair Children's Hospital NICU from December 2002 to December 2005 was performed. Preterm infants ≤ 1,500 g or ≤ 32 weeks gestation who received inotropic support were included. Patients were excluded for life-threatening congenital defects. Those infants who received epinephrine (epi) as an adjunctive inotropic agent were compared with infants who did not receive epinephrine (no-epi). Admission demographic data, BP, ABGs, and UOP were recorded. SNAPPE-II and CRIB-II scores were calculated. BP, HR, and ABGs were recorded prior to initiation and during inotropic support. The primary outcome variable was death. Data were analyzed with SPSS for Windows (V. 14; SPSS Inc). Eighty-eight infants were considered for analysis. There was a significant difference in BW and EGA between the groups; however, there was no difference in admitting diagnoses, BP, ABG, or UOP. There was a trend toward higher predicted mortality in the epi group. Prior to intervention, there was no difference in BP, HR, or ABGs. With intervention, the epi group demonstrated a higher maximum HR (p < .001) and maximum base excess (p < .05). Mortality was 23% in the no-epi group and 73% in the epi group (p < .001). Logistic regression analysis revealed that exposure to epinephrine increased the risk for death eightfold (p < .01). There was a trend to a higher epinephrine dose in those patients who expired. Scores of illness severity and acute physiology tended to underestimate the death rate in the epi group. We speculate that the higher epinephrine doses may have increased myocardial oxygen consumption in the patients who expired. Prospective trials using epinephrine as an inotropic agent are needed to asses the risks and benefits in the preterm infant.

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