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

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.

An Update on Pharmacologic Management of Neonatal Hypotension: When, Why, and Which Medication

“…In this line are the results of a recent retrospective cohort study in 115 term and preterm infants with hypotension. It was found that continuous infusion of EPI at low doses (<0.05 mcg/kg/min) resulted in a significant improvement in AP and urine output in 55% of the patients, without adverse effects [126].…”

“…Studies on EPI administration to hypotensive neonates are very limited, especially when considering preterm neonates [51,65,126]. An early retrospective study involving 31 VLBWI (GA 23-30 weeks), who did not respond to DOP infusion up to 15 mcg/kg/min, showed that EPI infusion at doses ranging from 0.05 and 2.6 mcg/kg/min significantly increased mean AP and HR, with a parallel increase in the base deficit [67].…”