Noradrenaline for management of septic shock refractory to fluid loading and dopamine or dobutamine in full-term newborn infants.
OBJECTIVE
To determine the effects of noradrenaline in full-term newborns with refractory septic shock.


METHODS
Newborns of >35 weeks' gestation with persistent septic shock, despite adequate fluid resuscitation and high dose of dopamine/dobutamine were eligible. In this prospective observational study, we recorded respiratory and hemodynamic parameters prior to and 3 h after starting noradrenaline infusion.


RESULTS
Twenty-two newborns were included (gestational age [GA] 39 +/- 1.7 weeks, birth weight (BW) 3110 +/- 780 g). Before starting noradrenaline, the infants received a mean volume expansion of 31 +/- 15 mL/kg and a mean infusion rate of dopamine of 14 +/- 5 microg/kg/min or dobutamine of 12 +/- 6 microg/kg/min. Three hours after starting noradrenaline (rate 0.5 +/- 0.4 microg/kg/min), the mean arterial blood pressure rose from 36 +/- 5 to 51 +/- 7 mmHg (p < 0.001). Urine output increased from 1 +/- 0.5 to 1.7 +/- 0.4 mL/kg/h (p < 0.05). Blood lactate concentration decreased from 4.8 +/- 2.3 to 3.3 +/- 1.8 mmol/L (p < 0.01). Despite an initial correction of hypotension, four infants died later.


CONCLUSIONS
Noradrenaline was effective in increasing systemic blood pressure. An increase in urine output and a decrease in blood lactate concentration suggest that noradrenaline may have improved cardiac function and tissue perfusion.
Tourneux
Pierre
P
Clinique de Médecine Néonatale, Hôpital Jeanne de Flandre, CHRU de Lille, France. tourneux.pierre@chu-amiens.fr
Rakza
Thameur
T
Abazine
Abdel
A
Krim
Gérard
G
Storme
Laurent
L
D001794:Blood Pressure / Q000187:drug effects; D004280:Dobutamine / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D005440:Fluid Therapy; D006801:Humans; D007231:Infant, Newborn; D007773:Lactates / Q000097:blood; D009638:Norepinephrine / Q000627:therapeutic use*; D011446:Prospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000628:therapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D007773:Lactates; D014662:Vasoconstrictor Agents; D004280:Dobutamine; D004298:Dopamine; D009638:Norepinephrine