Hospitals vary widely in their use of dopamine and dobutamine in preterm/low birthweight neonates
Dopamine and dobutamine are medications used to help preterm babies increase their heart output and blood pressure in the immediate newborn period. This use does not have Food and Drug Administration approval, and both medications have been prioritized for further study and drug labeling. One challenge to the design of studies assessing efficacy and safety is the lack of information about patterns of use.
A new study looked at 65,216 neonates to examine use of dopamine and dobutamine in 7,459 preterm or low birthweight (LBW) neonates, including 1,143 very low birthweight (VLBW) neonates. Dopamine or dobutamine was used for 4.9 percent (362) of neonates who were either preterm or LBW and 25.1 percent of VLBW neonates at 11 hospitals. Treatment with dopamine alone was more common than treatment with dobutamine alone. Neonates receiving both dopamine and dobutamine were more likely to have dopamine as the first treatment. Within this group, 251 were treated with dopamine, 20 with dobutamine, and 91 treated with both drugs. A significantly higher percentage of black neonates received dobutamine (45.5 percent) versus dopamine (27.3 percent). Most of the hospitals using these drugs were large and located in urban settings. In the 1,143 VLBW neonates, 194 received dopamine, 14 received dobutamine, and 79 received both drugs.
The probability of treatment of VLBW neonates with dopamine or dobutamine varied across 11 of the 421 hospitals with pediatric hospitalizations, ranging from 4.4 percent to 38.4 percent. However, hospitals varied in their prevalence of treatment with dopamine versus dobutamine. For example, three hospitals used dopamine only and six hospitals had greater than 50 percent of neonates receiving dopamine versus dobutamine. At only one hospital was dobutamine used more often than dopamine.
The researchers point out that this variation in hospital practice may be explained in part, by the scarcity of clinical studies and absence of labeling information for drugs used to treat hypotension in VLBW neonates. The study was supported by the Agency for Healthcare Research and Quality (HS17998).
See "Dopamine and dobutamine use in preterm or low birth weight neonates in the Premier 2008 Database," by Tamar Lasky, Ph.D., Jay Greenspan, M.D., M.B.A., Frank R. Ernst, Pharm.D., and Liliana Gonzalez, Ph.D., in Clinical Therapeutics 33(12), pp. 2082-2088, 2011.
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