Effect of dobutamine on the clinical course of preterm infants with mild hyaline membrane disease

Abstract

In contrast to the situation in severe hyaline membrane disease (HMD), cardiovascular status and effect of inotropic agent in mild HMD have not been investigated. This study aimed to study the effect of dobutamine on the clinical course of mild HMD. Preterm infants with mild HMD (those who did not require mechanical ventilation) were randomly assigned to either receive dobutamine 10 (μg/kg/minute or placebo in addition to standard supportive treatment. All patients were managed according to standard treatment at the Division of Perinatology, Department of Child Health, Medical School, University of Indonesia. The treatment was continued until each patient reached the age of 96 hours, or needed mechanical ventilation, or experienced life threatening clinical deterioration. Forty-one infants were enrolled in the study; 20 were treated with dobutamine and 21 with placebo. Clinical observation disclosed that there was no difference between heart rate and respiratory rate between the 2 groups, but systolic, diastolic, and mean arterial blood pressures were significantly higher in dobutamine-treated than in placebo-treated group. There were 8failures in placebo group and 7failures (including 1 with systolic hypertension) in the dobutamine group. There was no significant difference of the occurrence of treatment failure between the two groups. However, on survival analysis using Kaplan-Meier and Breslow testing it was observed that dobutamine-treated patients had a significantly longer mean mechanical-ventilation-free survival (mean: 78 hours; 95% confidence intervals: 70; 84 hours) than placebo- treated patients (mean: 61 hours; 95% confidence intervals 51;71 hours). Administration of dobutamine to standard treatment delays the deterioration of preterm infants with mild HMD, so that use of dobutamine 10 μg/kg/minute early in the course of the disease is recommended.