Evaluation of the causal effects between dopamine infusion changeover and fluctuations in mean arterial pressure in neonates

Katherine Kirupakaran, Paula de Sousa, Celine Le Roux, Lauren Redwood, Heike Rabe, Bhavik Patel

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: To evaluate whether changing dopamine infusions every 12 hours and preparing these infusions 30 min before administration reduces blood pressure fluctuations in preterm and term neonates.
Design: This was a retrospective study using data from live patients on the neonatal unit and prospective study exploring stability of infusions in a laboratory-based neonatal ward simulation.
Setting: Single-centre study in a tertiary neonatal surgical unit in a university teaching hospital.
Patients Neonates who received more than one subsequent dopamine infusion and had invasive arterial blood pressure monitoring, during their admission in the neonatal unit, were included.
Interventions: As part of the Quality Improvement project, the standard operating procedure (SOP) was changed, and dopamine infusions were prepared by nursing staff and left to rest for 30 min before administering to the neonate. Additionally, infusions were replaced every 12 hours.
Main outcome measures: The percentage change in mean arterial pressure (MAP) and the percentage loss in the drug concentration during infusion during changeover.
Results Our findings indicate that up to 15% of the initial dopamine concentration is lost after 24 hours. This results in a sharp variation in the dopamine concentration during infusion changeover that correlates with observed rapid fluctuations in MAP. In changing the SOP, no significant difference in the concentration of dopamine and MAP were observed over 12 hours.
Conclusions: Delaying administration of dopamine infusions by 30 min after preparation combined with changing infusions 12 hourly has reduced MAP fluctuations. Therefore, the risks associated with MAP fluctuations, including intraventricular haemorrhages, are reduced.
Original languageEnglish
JournalArchives of Disease in Childhood
DOIs
Publication statusPublished - 30 Aug 2019

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Dopamine
Arterial Pressure
Newborn Infant
Nursing Staff
Quality Improvement
Teaching Hospitals
Retrospective Studies
Outcome Assessment (Health Care)
Prospective Studies
Hemorrhage
Blood Pressure
Pharmaceutical Preparations

Bibliographical note

This article has been accepted for publication in Archives of Disease in Childhood, 2019, following
peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/archdischild-2019-317123

Keywords

  • intensive care
  • neonatology
  • pharmacology

Cite this

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title = "Evaluation of the causal effects between dopamine infusion changeover and fluctuations in mean arterial pressure in neonates",
abstract = "Objective: To evaluate whether changing dopamine infusions every 12 hours and preparing these infusions 30 min before administration reduces blood pressure fluctuations in preterm and term neonates.Design: This was a retrospective study using data from live patients on the neonatal unit and prospective study exploring stability of infusions in a laboratory-based neonatal ward simulation.Setting: Single-centre study in a tertiary neonatal surgical unit in a university teaching hospital.Patients Neonates who received more than one subsequent dopamine infusion and had invasive arterial blood pressure monitoring, during their admission in the neonatal unit, were included.Interventions: As part of the Quality Improvement project, the standard operating procedure (SOP) was changed, and dopamine infusions were prepared by nursing staff and left to rest for 30 min before administering to the neonate. Additionally, infusions were replaced every 12 hours.Main outcome measures: The percentage change in mean arterial pressure (MAP) and the percentage loss in the drug concentration during infusion during changeover.Results Our findings indicate that up to 15{\%} of the initial dopamine concentration is lost after 24 hours. This results in a sharp variation in the dopamine concentration during infusion changeover that correlates with observed rapid fluctuations in MAP. In changing the SOP, no significant difference in the concentration of dopamine and MAP were observed over 12 hours.Conclusions: Delaying administration of dopamine infusions by 30 min after preparation combined with changing infusions 12 hourly has reduced MAP fluctuations. Therefore, the risks associated with MAP fluctuations, including intraventricular haemorrhages, are reduced.",
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Evaluation of the causal effects between dopamine infusion changeover and fluctuations in mean arterial pressure in neonates. / Kirupakaran, Katherine; de Sousa, Paula; Le Roux, Celine; Redwood, Lauren ; Rabe, Heike; Patel, Bhavik.

In: Archives of Disease in Childhood, 30.08.2019.

Research output: Contribution to journalArticleResearchpeer-review

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AU - de Sousa, Paula

AU - Le Roux, Celine

AU - Redwood, Lauren

AU - Rabe, Heike

AU - Patel, Bhavik

N1 - This article has been accepted for publication in Archives of Disease in Childhood, 2019, following peer review, and the Version of Record can be accessed online at http://dx.doi.org/10.1136/archdischild-2019-317123

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N2 - Objective: To evaluate whether changing dopamine infusions every 12 hours and preparing these infusions 30 min before administration reduces blood pressure fluctuations in preterm and term neonates.Design: This was a retrospective study using data from live patients on the neonatal unit and prospective study exploring stability of infusions in a laboratory-based neonatal ward simulation.Setting: Single-centre study in a tertiary neonatal surgical unit in a university teaching hospital.Patients Neonates who received more than one subsequent dopamine infusion and had invasive arterial blood pressure monitoring, during their admission in the neonatal unit, were included.Interventions: As part of the Quality Improvement project, the standard operating procedure (SOP) was changed, and dopamine infusions were prepared by nursing staff and left to rest for 30 min before administering to the neonate. Additionally, infusions were replaced every 12 hours.Main outcome measures: The percentage change in mean arterial pressure (MAP) and the percentage loss in the drug concentration during infusion during changeover.Results Our findings indicate that up to 15% of the initial dopamine concentration is lost after 24 hours. This results in a sharp variation in the dopamine concentration during infusion changeover that correlates with observed rapid fluctuations in MAP. In changing the SOP, no significant difference in the concentration of dopamine and MAP were observed over 12 hours.Conclusions: Delaying administration of dopamine infusions by 30 min after preparation combined with changing infusions 12 hourly has reduced MAP fluctuations. Therefore, the risks associated with MAP fluctuations, including intraventricular haemorrhages, are reduced.

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