title: What is the evidence for the use of adrenaline in the treatment of neonatal hypotension?
abstract: OBJECTIVE
  The authors of this review present the current evidence of the physiology, indications and use of adrenaline in neonates, with particular focus on the treatment of hypotension.
  
  
  METHODS
  A structured literature search was performed across selected electronic databases, reference lists and related articles. Abstracts arising from the search were screened for relevance according to predefined inclusion criteria. Full articles for the selected abstracts were obtained and then reviewed. Articles were analysed through a two stage process until agreement was reached between the research team on the studies for inclusion.
  
  
  RESULTS
  We identified 187 animal and human studies (published between 1924-2011) using various methodologies but with two main themes: the physiology of endogenous adrenaline in neonates and the therapeutic uses of this hormone in neonatal medicine. The physiological studies measured catecholamine levels in cord blood, neonatal urine and blood, some in response to interventions such as suctioning, skin massage or morphine infusion. Within the therapeutic studies there was only one randomised controlled trial (RCT): a comparison of dopamine versus adrenaline involving 60 infants of < 32 weeks gestational age.
  
  
  CONCLUSIONS
  Despite the number of studies identified, we found few adequately-controlled studies on the therapeutic use of adrenaline in neonates. Future research should focus on RCTs comparing adrenaline to other commonly used inotropes.
authors.affiliation: Department of Neonatology, Royal Sussex County Hospital, Brighton & Sussex University Hospitals Trust, Eastern Road, Brighton, UK. Liam.Mahoney@doctors.org.uk
authors.forename: Liam
authors.initials: L
authors.lastname: Mahoney
authors.forename: David
authors.initials: D
authors.lastname: Crook
authors.forename: Kerstin N
authors.initials: KN
authors.lastname: Walter
authors.forename: Ella
authors.initials: E
authors.lastname: Sherman
authors.forename: Heike
authors.initials: H
authors.lastname: Rabe
mesh_terms: D004837:Epinephrine / Q000627:therapeutic use*; D006801:Humans; D007022:Hypotension / Q000188:drug therapy*; D007231:Infant, Newborn
chemical_list: D004837:Epinephrine