Abstract
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 language | English |
|---|---|
| Journal | Archives of Disease in Childhood |
| DOIs | |
| Publication status | Published - 30 Aug 2019 |
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Bibliographical note
This article has been accepted for publication in Archives of Disease in Childhood, 2019, followingpeer 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
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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 journal › Article › Research › peer-review
TY - JOUR
T1 - Evaluation of the causal effects between dopamine infusion changeover and fluctuations in mean arterial pressure in neonates
AU - Kirupakaran, Katherine
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
PY - 2019/8/30
Y1 - 2019/8/30
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.
AB - 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.
KW - intensive care
KW - neonatology
KW - pharmacology
UR - http://www.scopus.com/inward/record.url?scp=85071924076&partnerID=8YFLogxK
U2 - 10.1136/archdischild-2019-317123
DO - 10.1136/archdischild-2019-317123
M3 - Article
JO - Archives of Disease in Childhood
JF - Archives of Disease in Childhood
SN - 0003-9888
ER -