A randomized controlled trial of the impact of dopamine on outcome of asphyxiated neonates
Background: Vasoactive drugs such as low dosage dopamine are often used in the intensive care of asphyxiated term neonates but there is insufficient evidence to support the practice.
Aims: To evaluate the impact of low dose dopamine on the clinical course and outcome of newborns with severe perinatal asphyxia and to determine factors that predict survival.
Methods: This was a randomized controlled trial. Term asphyxiated newborns were alternately recruited into ‘dopamine’ and ‘nodopamine’ sub groups. Asphyxia was defined as Apgar score ≤3 at one minute or ≤5 at five minutes, and/or clinical evidence of hypoxic ischemic encephalopathy (HIE). The intervention comprised dopamine infusion at 3.0mcg/kg/minute. Primary outcome was death or survival till discharge while secondary measures were apnoea, oliguria, seizures and other clinical morbidities. The Student t-test was used to compare outcomes between the subgroups.
Results: A total of fifty five asphyxiated infants took part in the study: 27 in the intervention group while 28 were in the control group. The subgroups were similar in mean gestational age, Apgar scores, age at admission and modes of delivery (p>0.05). HIE occurred in over a half of the subjects. The frequency of apnoea, oxygen requirement, duration of anticonvulsant treatment and urine outputs were similar between the subgroups(p > 0.05).The mean durations of admission (days) were 5.13±3.0 and 5.3±3.0 for the intervention and non-intervention subgroupsrespectively (t=0.183, p=0.856). Likewise,survival rates were similar (x2 = 1.261, p = 0.948). Selected perinatal eventsdid not influence outcome (p>0.05).
Conclusion: Low-dosedopamine has no impact on the short term outcome of asphyxiated infants.
Key words: hypoxic ischemic encephalopathy, clinical course, outcome, dopamine