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LETTERS TO THE EDITOR

Small-Dose Dopamine in Critically Ill Infants and Children

Department of Pediatric Intensive Care, VU Medical Center, Amsterdam, The Netherlands Children’s Heart Centre, University Hospital St. Radboud, Nijmegen, The Netherlands, Dr. Van den Berghe does not wish to respond.

To the Editor:

The conclusion that widespread use of low-dose dopamine (LDD) in adult ICUs for renal protection is no longer justified can also be expanded to critically ill infants and children (1). A recent survey among all 19 neonatal and pediatric ICUs in the Netherlands showed that LDD is regularly used either to improve renal function or to enhance diuresis (2). However, evidence from well-performed clinical studies to support the use of LDD for improving renal function in critically ill neonates and children is largely insufficient. We recently published a systematic review on LDD in sick infants and children (2). Our literature review revealed only one randomized controlled trial (3). This trial reported no significant effects of dopamine on renal function or diuresis though there was a slight increase in natriuresis at a dose of 1 µ/kg/min. All other studies were nonrandomized and inconclusive.

However, in contrast to the adult population, this does not mean that there are no favorable effects, only that evidence is missing due to lack of studies to support either hypothesis. Since dopamine can also have adverse effects, we conclude that the use of LDD should be reconsidered until well-performed randomized controlled clinical trials have addressed this issue.

References

1. Debaveye YA, Van den Berghe GH. Is there still a place for dopamine in the modern intensive care unit ? Anesth Analg 2004; 98: 461–8.[Abstract/Free Full Text]
2. Prins I, Plötz FB, Uiterwaal CSPM, Vught AJ van. Low-dose dopamine in neonatal and paediatric intensive care: a systematic review. Intensiv Care Med 2001; 27: 206–10.
3. Cuevas L, Yeh TF, John EG, et al. The effect of low-dose dopamine infusion on cardiopulmonary and renal status in premature newborns with respiratory distress syndrome. Am J Dis Child 1991; 145: 799–803.[Abstract]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Plötz, F. B. Articles by Prins, I. Search for Related Content PubMed PubMed Citation Articles by Plötz, F. B. Articles by Prins, I.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999