Norepinephrine better than dopamine for managing sepsis-related hypotension in preterm infants

The retrospective cohort study over ten years showed that norepinephrine use was associated with lower morbidity and mortality than dopamine in preterm infants with sepsis.

Amish Jain from the University of Toronto in Toronto, ON, Canada, and colleagues aimed to compare the clinical effectiveness of dopamine versus norepinephrine as first-line therapy for hypotension related to sepsis in preterm infants. Dopamine is the most common vasoactive agent in preterm infants to support blood pressure (BP). Norepinephrine is recommended as the preferred treatment over dopamine for septic shock in adult patients.

"The study is the first to examine the relative clinical effectiveness of norepinephrine and dopamine as first-line pharmacotherapy for sepsis-related hypotension among preterm infants," they wrote.

The study was conducted over ten years at two tertiary neonatal units. It included preterm infants born at less than 35 weeks post-menstrual age (PMA) who received norepinephrine or dopamine as primary therapy for hypotension during sepsis, defined as culture-negative or culture-positive infections or necrotizing enterocolitis (NEC).

Of the 156 included infants, 43 received NE and 113 received DA. A comparison was drawn between the two groups on pre-discharge mortality, episode-related mortality (< 7 days from treatment), and significant morbidities among survivors. Adjustment of analyses was made using the inverse probability of treatment weighting estimated by propensity score (PS).

The study led to the following findings:

• The mean PMA at birth and treatment for the DA and NE groups were 25.8 vs. 25.2 weeks and 27.7 vs. 27.1 weeks, respectively.
• Pre-treatment, the NE group had higher mean airway pressure (14 vs. 12 cmH2O), heart rate (185 vs. 175 beats per minute), and the median fraction of inspired oxygen (0.67 vs. 0.52).
• After PS adjustment, NE was associated with lower episode-related mortality [adjusted odds ratio 0.55], pre-discharge mortality [0.60], a post-illness new diagnosis of significant neurologic injury [0.32], and subsequent occurrence of NEC/sepsis among the survivors [0.34].

"Among preterm infants, norepinephrine may be more effective than dopamine for management of sepsis-related hypotension," the researchers wrote. "These data provide a rationale for prospective assessment of these commonly used agents."

"Norepinephrine use may be linked with lower morbidity and mortality than dopamine in preterm infants with sepsis," they concluded.

Reference:

Nissimov, S., Joye, S., Kharrat, A. et al. Dopamine or norepinephrine for sepsis-related hypotension in preterm infants: a retrospective cohort study. Eur J Pediatr (2022). https://doi.org/10.1007/s00431-022-04758-4