Randomized trial of dobutamine versus dopamine in preterm infants with low systemic blood flow

Objective: Our purpose was to determine if dobutamine or dopamine results in greater improvements in systemic blood flow in very preterm infants with low flow during the first 24 hours of life. Study design: A 2-center, randomized, double-blind study. Infants (n = 42) with low superior vena cava (SVC) flow (<41 mL/kg/min) in the first 12 hours were randomly assigned to receive 10 mL/kg normal satire solution, Mowed by 10 mug/kg/minute of dobutamine or dopamine. If low flow persisted or recurred, the inotrope was increased to 20 mug/kg/minute, with crossover to the other inotrope if treatment faded to maintain flow. Results: Volume produced a more significant increase in SVC flow than dopamine (+43%). At the highest dose, dobutamine resulted in a significantly greater increase in SVC flow than dopamine (mean, +9.9 vs -3.2 mL/kg/min, P = .02). Dopamine resulted in a significantly greater increase in blood pressure. Infants receiving dobutamine only at 24 hours had a greater right ventricular output than infants receiving dopamine (mean, 295 vs 167 mL/kg/min, P < .001). Forty percent faded to increase or maintain SVC flow in response to either inotrope. No significant differences in mortality or morbidity were found. Conclusions: Dobutamine produced a greater increase in blood flow than dopamine.