Comparative efficacy of volume expansion, inotropes and vasopressors in preterm neonates with probable transitional circulatory instability in the first week of life: a systematic review and network meta-analysis.
BMJ Paediatr Open
; 8(1)2024 May 20.
Article
in En
| MEDLINE
| ID: mdl-38769048
ABSTRACT
BACKGROUND:
There exists limited agreement on the recommendations for the treatment of transitional circulatory instability (TCI) in preterm neonatesOBJECTIVE:
To compare the efficacy of various interventions used to treat TCIMETHODS:
Medline and Embase were searched from inception to 21st July 2023. Two authors extracted the data independently. A Bayesian random effects network meta-analysis was used. Recommendations were formulated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework.INTERVENTIONS:
Dopamine, dobutamine, epinephrine, hydrocortisone, vasopressin, milrinone, volume and placebo. MAIN OUTCOMEMEASURES:
Mortality, major brain injury (MBI) (intraventricular haemorrhage > grade 2 or cystic periventricular leukomalacia), necrotising enterocolitis (NEC) ≥stage 2 and treatment response (as defined by the author).RESULTS:
15 Randomized Controlled Trials (RCTs) were included from the 1365 titles and abstracts screened. Clinical benefit or harm could not be ruled out for the critical outcome of mortality. For the outcome of MBI, epinephrine possibly decreased the risk when compared to dobutamine and milrinone (very low certainty). Epinephrine was possibly associated with a lesser risk of NEC when compared with dopamine, dobutamine, hydrocortisone and milrinone (very low certainty). Dopamine was possibly associated with a lesser risk of NEC when compared with dobutamine (very low certainty). Vasopressin possibly decreased the risk of NEC compared with dopamine, dobutamine, hydrocortisone and milrinone (very low certainty). Clinical benefit or harm could not be ruled out for the outcome response to treatment.CONCLUSIONS:
Epinephrine may be used as the first-line drug in preterm neonates with TCI, the evidence certainty being very low. We suggest future trials evaluating the management of TCI with an emphasis on objective criteria to define it.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Vasoconstrictor Agents
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Infant, Premature
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Cardiotonic Agents
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Network Meta-Analysis
Limits:
Humans
/
Newborn
Language:
En
Journal:
BMJ Paediatr Open
Year:
2024
Document type:
Article
Affiliation country:
Country of publication: