Inotrope use among extremely preterm infants in Canadian neonatal intensive care units: variation and outcomes.
OBJECTIVE
To compare neonatal outcomes between infants who received inotropes and those who did not, and identify variation in inotrope use.


METHODS
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]).


CONCLUSIONS
Risk of mortality and major morbidities were significantly higher in neonates who received inotropes. Inotrope use varied significantly among Canadian neonatal intensive care units.
Department of Pediatrics, Kingston General Hospital, Kingston, Ontario, Canada.
Jonathan
J
Wong
Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
Prakesh S
PS
Shah
MiCare Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
Eugene W
EW
Yoon
Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
Wendy
W
Yee
Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
Shoo
S
Lee
Department of Pediatrics, Kingston General Hospital, Kingston, Ontario, Canada.
Kimberly
K
Dow
D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology*; D002170:Canada / Q000453:epidemiology; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000453:epidemiology*; D002552:Cerebral Ventricles; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000188:drug therapy* / Q000453:epidemiology; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008297:Male; D009026:Mortality; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012178:Retinopathy of Prematurity / Q000453:epidemiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index
D002316:Cardiotonic Agents; D011663:Pulmonary Surfactants