RANDOMIZED TRIAL OF DOPAMINE COMPARED WITH HYDROCORTISONE FOR THE TREATMENT OF HYPOTENSIVE VERY-LOW-BIRTH-WEIGHT INFANTS

Aim-To compare the efficacy of hydrocortisone with dopamine for the tr eatment of hypotensive, very low birthweight (VLBW) infants. Methods-F orty infants were randomly allocated to receive either hydrocortisone (n=21) or dopamine (n=19). Results-All 19 infants randomised to dopami ne responded; 17 of 21 (81%) did so in the hydrocortisone group. Three of the four non-responders in the hydrocortisone group had clinically significant left to right ductal shunting. The incidence of bronchopu lmonary dysplasia, retinopathy of prematurity, intraventricular haemor rhage, necrotising enterocolitis, symptomatic patent ductus arteriosus , hyperglycaemia, sepsis (bacterial or fungal) or survival did not dif fer between groups. The adrenocorticotrophic hormone (ACTH) stimulated plasma cortisol activity, either before or after treatment, did not d iffer between the two groups of infants. Although a significant differ ence in efficacy between dopamine and hydrocortisone was not noted (P = 0.108), there were four treatment failures in the hydrocortisone gro up, compared with none in the dopamine group.Conclusion-Both hydrocort isone and dopamine are effective treatments for hypotension in very lo w birthweight infants.