Department of Neonatal Medicine, Osaka Women's and Children's Hospital, 840 Murodo-cho, Izumi, Osaka, 594-1101, Japan.
Eur J Pediatr. 2020 Nov;179(11):1797-1803. doi: 10.1007/s00431-020-03676-7. Epub 2020 May 26.
This study aimed to assess the effect of dopamine on the development of infections after birth in extremely preterm infants. We retrospectively identified 258 extremely preterm infants (born at < 28 gestational weeks) between July 2009 and December 2018 in a tertiary neonatal intensive care unit (NICU). We extracted data on potential risk factors for infection, total amount of dopamine, and infection history during NICU stay for each infant. We compared the infection group with the non-infection group, and used the Cox proportional hazard regression analysis to identify risk factors for infection during NICU stay. After adjustment for all potential risk factors, factors that significantly affected development of infection were gestational age (hazard ratio [HR], 0.70; 95% confidence interval [CI] 0.55-0.89; p = 0.004) and total amount of dopamine (HR, 1.04; 95% CI 1.02-1.07; p = 0.002). The receiver operating characteristic curve of total amount of dopamine for infection suggested that total amount of dopamine greater than 7.271 mg/kg predicted infection development with 80.4% sensitivity and 41.7% specificity.Conclusion: A large amount of dopamine can increase infections in extremely preterm infants. We should avoid using a large amount of dopamine and remain aware of the potential development of infections in extremely preterm infants. What is Known: • Inotropes are often used for extremely preterm infants and dopamine is the most commonly used inotrope. • However, it is suggested that dopamine affects the immune system and related infections. What is New: • This is the first study of the association between the amount of dopamine and infection in extremely preterm infants. • We should avoid using a large amount of dopamine in extremely preterm infants.
本研究旨在评估多巴胺对极早产儿出生后感染发展的影响。我们回顾性地确定了 2009 年 7 月至 2018 年 12 月在一家三级新生儿重症监护病房（NICU）出生的 258 名极早产儿（<28 孕周）。我们从每个婴儿的 NICU 住院期间提取了潜在感染危险因素、多巴胺总量和感染史的数据。我们比较了感染组和非感染组，并使用 Cox 比例风险回归分析确定了 NICU 住院期间感染的危险因素。在调整了所有潜在的危险因素后，显著影响感染发展的因素是胎龄（风险比[HR]，0.70；95%置信区间[CI]，0.55-0.89；p = 0.004）和多巴胺总量（HR，1.04；95%CI，1.02-1.07；p = 0.002）。多巴胺总量对感染的受试者工作特征曲线表明，多巴胺总量大于 7.271mg/kg 可预测感染发展，其敏感性为 80.4%，特异性为 41.7%。结论：大量多巴胺可增加极早产儿的感染。我们应避免使用大量多巴胺，并注意极早产儿感染的潜在发展。已知：• 正性肌力药常用于极早产儿，多巴胺是最常用的正性肌力药。• 然而，有研究表明多巴胺会影响免疫系统并导致相关感染。新发现：• 这是首例关于极早产儿多巴胺用量与感染关系的研究。• 我们应避免在极早产儿中使用大量多巴胺。
