Hunt R, Osborn D
Neonatal Neurology, Royal Women's and Royal Children's Hospitals, Melbourne, Level 2, Royal Children's Hospital, Flemington Road, Parkville, VIC, Australia, 3052.
Cochrane Database Syst Rev. 2002;2002(3):CD003484. doi: 10.1002/14651858.CD003484.
Perinatal asphyxia remains an important condition with significant mortality and long-term morbidity. Multisystem involvement including hypotension and low cardiac output is common in infants with perinatal asphyxia. Dopamine is commonly used for infants with hypotension of any etiology, with the goal of improving cardiac output and preventing its detrimental consequences.
To determine if dopamine, compared to placebo, no treatment, volume or another inotrope reduces morbidity and mortality in term newborn infants with suspected perinatal asphyxia.
The standard search strategy of the Neonatal Review Group was used. Searches were conducted of the Oxford Database of Perinatal Trials, Cochrane Controlled Trials Register (The Cochrane Library, Issue 1, 2002), MEDLINE (1966 to March 2002), previous reviews including cross references, abstracts and conference proceedings (Perinatal Society of Australia and New Zealand 1998-2002 and Pediatric Academic Societies meetings 1998-2001).
Randomised controlled trials comparing dopamine with placebo, no treatment, other inotropic agents, or volume in infants greater than 36 weeks gestation. Perinatal asphyxia could be suspected on the basis of a cord blood pH < 7.0, cord blood base excess < -16 mEq/L or 5 minute Apgar score < 6.
Standard methods of the Cochrane Neonatal Review Group with use of relative risk (RR), risk difference (RD) and weighted mean difference (WMD). The fixed effects model using RevMan 4.1 was used for meta-analysis. Data from individual studies were only eligible for inclusion if at least 75% of participants were followed up.
Only one study (DiSessa 1981) was eligible. This study compared low dose dopamine at 2.5 mcg/kg/min with placebo (dextrose in water). This study enrolled 14 term infants with a 5 minute Apgar <6 and a systolic BP >=50 mmHg at a mean of 10 hours age. Seven infants only were randomised to treatment with dopamine and seven to receive placebo. No significant differences between these two groups were found for mortality or long term neurodevelopmental outcome. Length of hospitalisation was not significantly different between the two groups. No study was found that examined the effect of dopamine in infants with evidence of cardiovascular compromise, nor were any studies identified in which dopamine was compared to other inotropic agents for term infants with suspected asphyxia.
REVIEWER'S CONCLUSIONS: There is currently insufficient evidence from randomised controlled trials that the use of dopamine in term infants with suspected perinatal asphyxia improves mortality or long-term neurodevelopmental outcome. The question of whether dopamine improves outcome for term infants with suspected perinatal asphyxia has not been answered. Further research is required to determine whether or not the use of dopamine improves mortality and long-term morbidity for these infants and if so, issues such as which infants, at what dose and with what co-interventions should be addressed.
围产期窒息仍然是一种重要病症，具有较高的死亡率和长期发病率。多系统受累，包括低血压和低心输出量，在围产期窒息婴儿中很常见。多巴胺常用于任何病因引起的低血压婴儿，目的是改善心输出量并预防其有害后果。
确定与安慰剂、不治疗、补液或其他正性肌力药物相比，多巴胺是否能降低疑似围产期窒息足月儿的发病率和死亡率。
采用新生儿综述组的标准检索策略。检索了牛津围产期试验数据库、Cochrane对照试验注册库（《Cochrane图书馆》，2002年第1期）、MEDLINE（1966年至2002年3月）、以往的综述，包括交叉参考文献、摘要和会议记录（澳大利亚和新西兰围产期协会1998 - 2002年以及儿科学术协会会议1998 - 2001年）。
比较多巴胺与安慰剂、不治疗、其他正性肌力药物或补液在孕周大于36周婴儿中的随机对照试验。根据脐血pH < 7.0、脐血碱剩余 < -16 mEq/L或5分钟阿氏评分 < 6可怀疑存在围产期窒息。
采用Cochrane新生儿综述组的标准方法，使用相对危险度（RR）、危险度差值（RD）和加权均数差值（WMD）。使用RevMan 4.1软件的固定效应模型进行荟萃分析。只有当至少75%的参与者得到随访时，来自个体研究的数据才符合纳入标准。
仅有一项研究（迪塞萨，1981年）符合条件。该研究将2.5 mcg/kg/min的低剂量多巴胺与安慰剂（水中葡萄糖）进行比较。该研究纳入了14名足月儿，平均年龄10小时，5分钟阿氏评分 < 6且收缩压 >=50 mmHg。仅7名婴儿被随机分配接受多巴胺治疗，7名接受安慰剂治疗。两组在死亡率或长期神经发育结局方面未发现显著差异。两组住院时间也无显著差异。未发现研究多巴胺对有心血管功能不全证据婴儿的影响，也未发现将多巴胺与其他正性肌力药物用于疑似窒息足月儿进行比较的研究。
目前随机对照试验中没有足够证据表明，在疑似围产期窒息足月儿中使用多巴胺能改善死亡率或长期神经发育结局。多巴胺是否能改善疑似围产期窒息足月儿的结局这一问题尚未得到解答。需要进一步研究以确定使用多巴胺是否能改善这些婴儿的死亡率和长期发病率，如果能改善，还应解决诸如哪些婴儿、使用何种剂量以及联合何种干预措施等问题。
