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Efficacy of Low-Dose Epinephrine Continuous Infusion in Neonatal Intensive Care Unit Patients
Journal article   Open access   Peer reviewed

Efficacy of Low-Dose Epinephrine Continuous Infusion in Neonatal Intensive Care Unit Patients

Gloria Lee, Jeffrey R. Kaiser, Brady S. Moffett, Emily Rodman, Cynthia Toy and Danielle R. Rios
The journal of pediatric pharmacology and therapeutics, Vol.26(1), pp.51-55
01/01/2021
DOI: 10.5863/1551-6776-26.1.51
PMCID: PMC7792137
PMID: 33424500
url
https://europepmc.org/articles/pmc7792137View
Published (Version of record) Open Access

Abstract

OBJECTIVES Although epinephrine is used in the neonatal intensive care unit, few data exist on efficacy of doses <0.05 mcg/kg/min. This study evaluates the efficacy and safety of low-dose epinephrine continuous infusion at doses <0.05 mcg/kg/min in infants. METHODS Single-center, retrospective review of hypotensive infants from 2011–2018. Charts were reviewed for initial and maximum epinephrine doses, additional vasoactive agents, short-term efficacy, and adverse effects. The primary outcome was percentage of patients initiated on low-dose epinephrine whose dose did not require titration to ≥0.05 mcg/kg/min. RESULTS A total of 115 patients met study criteria with 131 distinct occurrences of low-dose epinephrine initiation. Most patients were unresponsive to other vasopressors at the time of epinephrine initiation. The median (IQR) starting dose of low-dose epinephrine was 0.01 (0.01–0.04) mcg/kg/min and median (IQR) maximum dose was 0.04 (0.02–0.08) mcg/kg/min. Fifty-five percent were responders. Patients in this cohort demonstrated significant improvement of blood pressure and urine output (p < 0.001) without adverse effects. CONCLUSIONS Low-dose epinephrine infusion may be considered as an alternative treatment to standard starting doses in hypotensive neonatal intensive care unit patients.

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