Evaluation of the causal effects between dopamine infusion changeover and fluctuations in mean arterial pressure in neonates

Kirupakaran, Katherine, de Sousa, Paula, Le Roux, Celine, Redwood, Lauren, Rabe, Heike and Anil Patel, Bhavik (2020) Evaluation of the causal effects between dopamine infusion changeover and fluctuations in mean arterial pressure in neonates. Archives of Disease in Childhood, 105 (4). pp. 390-394. ISSN 0003-9888

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Abstract

Objective
To evaluate whether changing dopamine infusions every 12 hours and preparing these infusions 30 min before administration reduces blood pressure fluctuations in preterm and term neonates.

Design
This was a retrospective study using data from live patients on the neonatal unit and prospective study exploring stability of infusions in a laboratory-based neonatal ward simulation.

Setting
Single-centre study in a tertiary neonatal surgical unit in a university teaching hospital.

Patients
Neonates who received more than one subsequent dopamine infusion and had invasive arterial blood pressure monitoring, during their admission in the neonatal unit, were included.

Interventions
As part of the Quality Improvement project, the standard operating procedure (SOP) was changed, and dopamine infusions were prepared by nursing staff and left to rest for 30 min before administering to the neonate. Additionally, infusions were replaced every 12 hours.

Main outcome measures
The percentage change in mean arterial pressure (MAP) and the percentage loss in the drug concentration during infusion during changeover.

Results
Our findings indicate that up to 15% of the initial dopamine concentration is lost after 24 hours. This results in a sharp variation in the dopamine concentration during infusion changeover that correlates with observed rapid fluctuations in MAP. In changing the SOP, no significant difference in the concentration of dopamine and MAP were observed over 12 hours.

Conclusions
Delaying administration of dopamine infusions by 30 min after preparation combined with changing infusions 12 hourly has reduced MAP fluctuations. Therefore, the risks associated with MAP fluctuations, including intraventricular haemorrhages, are reduced.

Item Type: Article
Schools and Departments: Brighton and Sussex Medical School > Brighton and Sussex Medical School
Subjects: R Medicine > RJ Pediatrics > RJ0251 Newborn infants Including physiology, care, treatment, diseases
Depositing User: Katie Isaac
Date Deposited: 11 Sep 2019 15:35
Last Modified: 21 May 2021 09:00
URI: http://sro.sussex.ac.uk/id/eprint/86004

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