Inotrope Use among Extremely Preterm Infants in Canadian Neonatal Intensive Care Units: Variation and Outcomes

Jonathan Wong; Prakesh S. Shah; Eugene W. Yoon; Wendy Yee; Shoo Lee; Kimberly Dow

doi:10.1055/s-0034-1371703

American Journal of Perinatology, Table of Contents

Am J Perinatol 2015; 32(01): 009-014
DOI: 10.1055/s-0034-1371703

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Inotrope Use among Extremely Preterm Infants in Canadian Neonatal Intensive Care Units: Variation and Outcomes

Authors

Jonathan Wong

¹Department of Pediatrics, Kingston General Hospital, Kingston, Ontario, Canada
Prakesh S. Shah

²Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
Eugene W. Yoon

³MiCare Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
Wendy Yee

⁴Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
Shoo Lee

²Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
Kimberly Dow

¹Department of Pediatrics, Kingston General Hospital, Kingston, Ontario, Canada

Abstract

Objective To compare neonatal outcomes between infants who received inotropes and those who did not, and identify variation in inotrope use.

Study Design Retrospective review of data from neonates < 29 weeks gestation collected by the Canadian Neonatal Network during 2003 to 2010. After controlling for confounders and maternal/infant characteristics, rates of mortality and major morbidity were compared between those who received inotropes on days 1 and 3 of admission and those who did not. Rate of inotrope use was compared between sites.

Results Inotropes were administered to 772 (10%) of the 7,913 neonates. Infants who received inotropes had significantly higher illness severity, surfactant use, and need for mechanical ventilation. Inotrope use was also associated with significantly higher rates of mortality (adjusted odds ratio [AOR] = 2.05 [1.64, 2.57]), retinopathy of prematurity (AOR = 2.04 [1.54, 2.71]), intraventricular hemorrhage (AOR = 1.59 [1.29, 1.93]), bronchopulmonary dysplasia (AOR = 1.38 [1.11, 1.72]), and necrotizing enterocolitis (AOR = 2.06 [1.59, 2.67]). Rates of inotrope use varied significantly between participating sites (0–36%; AOR = 0 [0, 0.1]–7.7 [2.9, 21]).

Conclusion Risk of mortality and major morbidities were significantly higher in neonates who received inotropes. Inotrope use varied significantly among Canadian neonatal intensive care units.

Keywords

infant - premature - inotrope - mortality - morbidity - variation

Full Text

References

References
1 Al-Aweel I, Pursley DM, Rubin LP, Shah B, Weisberger S, Richardson DK. Variations in prevalence of hypotension, hypertension, and vasopressor use in NICUs. J Perinatol 2001; 21 (5) 272-278
2 Dempsey EM, Barrington KJ. Treating hypotension in the preterm infant: when and with what: a critical and systematic review. J Perinatol 2007; 27 (8) 469-478
3 Batton B, Li L, Newman NS , et al; Eunice Kennedy Shriver National Institute of Child Health & Human Development Neonatal Research Network. Use of antihypotensive therapies in extremely preterm infants. Pediatrics 2013; 131 (6) e1865-e1873
4 Osborn D, Paradisis M, Evans N. The effect of inotropes on morbidity and mortality in preterm infants with low systemic or organ blood flow. Cochrane Database Syst Rev 2007; 24 (1) CD005090
5 Osborn D, Evans N, Kluckow M. Randomized trial of dobutamine versus dopamine in preterm infants with low systemic blood flow. J Pediatr 2002; 140 (2) 183-191
6 Golder V, Hepponstall M, Yiallourou SR, Odoi A, Horne RS. Autonomic cardiovascular control in hypotensive critically ill preterm infants is impaired during the first days of life. Early Hum Dev 2013; 89 (6) 419-423
7 Valverde E, Pellicer A, Madero R, Elorza D, Quero J, Cabañas F. Dopamine versus epinephrine for cardiovascular support in low birth weight infants: analysis of systemic effects and neonatal clinical outcomes. Pediatrics 2006; 117 (6) e1213-e1222
8 Logan JW, O'Shea TM, Allred EN , et al; ELGAN Study Investigators. Early postnatal hypotension is not associated with indicators of white matter damage or cerebral palsy in extremely low gestational age newborns. J Perinatol 2011; 31 (8) 524-534
9 Logan JW, O'Shea TM, Allred EN , et al; ELGAN Study Investigators. Early postnatal hypotension and developmental delay at 24 months of age among extremely low gestational age newborns. Arch Dis Child Fetal Neonatal Ed 2011; 96 (5) F321-F328
10 Garner RS, Burchfield DJ. Treatment of presumed hypotension in very low birthweight neonates: effects on regional cerebral oxygenation. Arch Dis Child Fetal Neonatal Ed 2013; 98 (2) F117-F121
11 Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores. J Pediatr 2001; 138 (1) 92-100
12 International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 2005; 123 (7) 991-999
13 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (4) 529-534
14 Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM. Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics 1988; 82 (4) 527-532
15 Bell MJ, Ternberg JL, Feigin RD , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (1) 1-7
16 Canadian Neonatal Network. Abstractor's manual. Toronto: Canadian Neonatal Network; 2010
17 Osborn DA, Evans N, Kluckow M, Bowen JR, Rieger I. Low superior vena cava flow and effect of inotropes on neurodevelopment to 3 years in preterm infants. Pediatrics 2007; 120 (2) 372-380
18 Synnes AR, Chien LY, Peliowski A, Baboolal R, Lee SK ; Canadian NICU Network. Variations in intraventricular hemorrhage incidence rates among Canadian neonatal intensive care units. J Pediatr 2001; 138 (4) 525-531
19 Short BL, Van Meurs K, Evans JR ; Cardiology Group. Summary proceedings from the cardiology group on cardiovascular instability in preterm infants. Pediatrics 2006; 117 (3 Pt 2) S34-S39
20 Seri I, Evans J. Controversies in the diagnosis and management of hypotension in the newborn infant. Curr Opin Pediatr 2001; 13 (2) 116-123
21 Van Marter LJ, Leviton A, Allred EN, Pagano M, Kuban KC. Hydration during the first days of life and the risk of bronchopulmonary dysplasia in low birth weight infants. J Pediatr 1990; 116 (6) 942-949
22 Goldberg RN, Chung D, Goldman SL, Bancalari E. The association of rapid volume expansion and intraventricular hemorrhage in the preterm infant. J Pediatr 1980; 96 (6) 1060-1063
23 Ewer AK, Tyler W, Francis A, Drinkall D, Gardosi JO. Excessive volume expansion and neonatal death in preterm infants born at 27-28 weeks gestation. Paediatr Perinat Epidemiol 2003; 17 (2) 180-186
24 Batton BJ, Li L, Newman NS , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Feasibility study of early blood pressure management in extremely preterm infants. J Pediatr 2012; 161 (1) 65-69 , e1
25 Lee SK, Zupancic JA, Pendray M , et al; Canadian Neonatal Network. Transport risk index of physiologic stability: a practical system for assessing infant transport care. J Pediatr 2001; 139 (2) 220-226