The effect of inotropes on morbidity and mortality in preterm infants with low systemic or organ blood flow.

摘要: BACKGROUND Low systemic blood flow (SBF) is common in extremely premature infants the first day after birth and has been associated with peri / intraventricular haemorrhage (PIVH), necrotising enterocolitis (NEC), mortality developmental impairment. OBJECTIVES To determine effect of specific inotropes on morbidity preterm low SEARCH STRATEGY Searches were made The Cochrane Central Register Controlled Trials (CENTRAL, Library, Issue 1, 2006 ), MEDLINE (1966 - April 2006), EMBASE (1980 2006) CINAHL (1982 supplemented by searches abstracts conference proceedings, citations reviews expert informants. SELECTION CRITERIA Random quasi-random controlled trials enrolling or organ neonatal period. DATA COLLECTION AND ANALYSIS Independent assessment trial eligibility, quality data extraction each review author. Synthesis using relative risk (RR) weighted mean difference (WMD) standard methods Collaboration. MAIN RESULTS No studies that compared an inotrope to no treatment SBF found. One study (Osborn 2002a) was found dobutamine versus dopamine. adequate methodology. It enrolled 42 40 ml/kg/min. significant reported discharge (RR 1.41, 95% CI 0.79, 2.52), PIVH 1.01, 0.52, 1.97), grade 3 4 0.39, 0.12, 1.31) NEC. At three years, there cerebral palsy, deafness, Developmental quotient > 2 sd below norm combined disability 0.10, 0.01, 1.56). Surviving treated had a significantly higher development (MD 35.00, 17.68, 52.32). There death at latest time 0.95, 0.66, 1.38). For secondary outcomes, periventricular leucomalacia, renal impairment, pulmonary haemorrhage, retinopathy prematurity CLD 36 weeks. failure. Dobutamine produced greater increase SVC highest dose reached 13.10, 2.87, 23.33), whereas dopamine BP 10 20 mug/kg/min -7.20, -11.41, -2.99). AUTHORS' CONCLUSIONS In flow, some evidence better than increasing maintaining flow. only eligible did not demonstrate any consistent differences clinical outcomes. However, this sufficiently powered prove disprove effects unclear what most effective strategy for improving cardiovascular status immature day. Further are needed strategies preventing