Randomized double-blind trial of dopamine versus epinephrine for treatment of hypotension in premature infants with respiratory distress syndrome

OBJECTIVE: To compare the efficacy of Dopamine and Epinephrine for the treatment of hypotension in premature infants with respiratory distress syndrome (RDS). METHODS: Infants ≤ 34 weeks gestation with RDS and a mean blood pressure (BP) of < 30 mmHg within the first 24 hours of life were enrolled and randomly assigned to either Dopamine (2.5 mcg/kg/min) or Epinephrine (0.25 mcg/kg/min); study drug could be increased in increments of 2.5 mcg/kg/min to a maximum of 10 mcg/kg/min (Dopamine), and increments of 0.25 mcg/kg/min to 1 mcg/kg/min (Epinephrine). Changes were made every 20 minutes if BP did not respond. The infant was considered a treatment failure if the infant did not respond to the drug after 30 minutes at the highest concentration. The study period was 72 hours from the time of enrollment. RESULTS: Fifteen infants were enrolled and 13 met study criteria: Dopamine (n=7), Epinephrine (n=6). Mean gestational age, birthweight, mean BP prior to starting the drug, heart rate, admission hematocrit, age at onset of hypotension, and Apgar scores were similar in the two groups. Infants in both groups responded to the study drug; one infant was removed from the study by the attending neonatologist due to decreased BP secondary to pericardial effusion. Mean (± SD) duration of the study was 63 ± 21 (Dopamine) and 50 ± 21 hours (Epinephrine). There were no significant differences in HR or BP, urine output, doses of surfactant, or oxygen index between the two groups. However, there appeared to be a trend toward greater BP variability in the Epinephrine group. One infant in each study group died (cardiac dysfunction and undiagnosed coarctation of aorta). Intraventricular hemorrhage grade III/IV was present in 3/6 (Dopamine) and 3/7 (Epinephrine) infants. CONCLUSION: There was no significant difference between the outcome measures of infants with RDS treated with Dopamine or Epinephrine for hypotension.