Low-dose dopamine in neonatal and pediatric intensive care: a systematic review

Objectives: To assess the current use of low-dose dopamine (< 5 g/kg per minute) to improve renal function and urine volume (UV) in neonatal (NICU) and pediatric (PICU) intensive care units, and to assess the available evidence to support this practice. Design: A written survey was used to assess the current use of low-dose dopamine among all 19 NICUs and PICUs in the Netherlands. In addition, a review of the literature of clinical intervention studies in which low-dose dopamine was administered to improve renal function and UV was performed. Methods: The clinical intervention studies focused on preterm neonates, critically ill infants and children, and those who underwent cardiac surgery. Either creatinine clearance or glomerular filtration rate and increase in UV were used to measure renal function improvement. Results: Our survey showed that among the 19 NICUs and PICUs, dopamine is regularly used either to improve renal function (n = 7) or to enhance UV (n = 13). The literature review identified seven clinical studies. Of these only one was a randomized controlled trial in preterm neonates, and this showed no positive correlation between renal function and UV. The other studies were uncontrolled experiments in preterm infants that claimed positive effects on UV (n = 5) and creatinine clearance (n = 2). Conclusions: The widespread use today of low-dose dopamine in Dutch NICUs and PICUs is not supported in the literature. Evidence from well performed clinical studies to support the use of low-dose dopamine for improving renal function and UV in critically ill neonates and children is largely insufficient. In view of adverse effects, the use of low-dose dopamine in neonatal and pediatric intensive care patients should be reconsidered.