RANDOMIZED, BLIND TRIAL OF DOPAMINE VERSUS DOBUTAMINE FOR TREATMENT OF HYPOTENSION IN PRETERM INFANTS WITH RESPIRATORY-DISTRESS SYNDROME

To compare the efficacy of dopamine and dobutamine for the treatment o f hypotension (mean arterial blood pressure, less than or equal to 30 mm Hg) in preterm (less than or equal to 34 weeks of gestation) infant s with respiratory distress syndrome in the first 24 hours of life, we enrolled 63 hypotensive preterm infants in a randomized, blind trial. Inclusion criteria required an arterial catheter for measurement of m ean arterial blood pressure, treatment with exogenous surfactant, and persistent hypotension after volume expansion with 20 ml/kg (packed er ythrocytes if hematocrit <0.40, 5% albumin if greater than or equal to 0.40). Intravenous study drug infusions were initiated at 5 mu g/kg p er minute and then increased in increments of 5 mu g/kg per minute at 20-minute intervals until a mean arterial blood pressure >30 mm Hg was attained and sustained for greater than or equal to 30 minutes (succe ss) or a maximum rate of 20 mu g/kg per minute was reached without res olution of hypotension (failure). The study groups at entry were compa rable for birth weight, gestational age, postnatal age, gender, birth depression, hematocrit <0.40, heart rate, oxygenation index, delivery route, maternal chorioamnionitis, and maternal magnesium or ritodrine therapy. No infants in the dopamine group had a treatment failure (0/3 1; 0%); (16%) of 32 infants failed to respond to dobutamine (p = 0.028 .). Success was attained at less than or equal to 10 mu g/kg per minut e in 30 (97%) of 31 infants given dopamine and in 22 (69%) of 32 infan ts given dobutamine (p <0.01). Among those treated successfully, the i ncrease in mean arterial blood pressure was significantly higher in th ose given dopamine (mean, 11.3 vs 6.8 mm Hg; p = 0.003). We conclude t hat dopamine is more effective than dobutamine for the early treatment of hypotension in preterm infants with respiratory distress syndrome.