Published online August 1, 2007
PEDIATRICS Vol. 120 No. 2 August 2007, pp. 372-380 (doi:10.1542/peds.2006-3398)
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ARTICLE

Low Superior Vena Cava Flow and Effect of Inotropes on Neurodevelopment to 3 Years in Preterm Infants

David A. Osborn, MM, FRACP, PhDa,b, Nick Evans, MRCPCH, MDa,b, Martin Kluckow, FRACP, PhDb,c, Jennifer R. Bowen, FRACPb,c and Ingrid Rieger, FRACPa,b

a Royal Prince Alfred Newborn Care, Royal Prince Alfred Hospital, Camperdown, Australia
b Department of Obstetrics and Gynaecology, University of Sydney, Sydney, Australia
c Department of Neonatology, Royal North Shore Hospital, St Leonards, Australia

OBJECTIVE. The goal was to report the 1- and 3-year outcomes of preterm infants with low systemic blood flow in the first day and the effect of dobutamine versus dopamine for treatment of low systemic blood flow.

METHODS. A cohort of 128 infants born at <30 weeks of gestation underwent echocardiographic measurement of superior vena cava flow at 3, 10, and 24 hours of age. Forty-two infants with low superior vena cava flow (<41 mL/kg per minute) were assigned randomly to dobutamine or dopamine. Surviving infants underwent blinded neurodevelopmental assessments at corrected ages of 1 and 3 years.

RESULTS. Seventy-six of 87 surviving infants were seen at 1 year and 67 at 3 years. Forty-four infants had low superior vena cava flow. At 3 years, with adjustment for perinatal risk factors, death was predicted by low superior vena cava flow, lower gestational age, and low 5-minute Apgar score. Substantial reductions in the Griffiths General Quotient were associated with low superior vena cava flow and birth weight of <10th percentile. Infants with low flow had significant reductions in personal-social, hearing and speech, and performance subscales. Death or disability at 3 years was predicted by low superior vena cava flow and lower gestational age. For infants treated with inotropes, no significant differences were found in clinical outcomes, except for reduced rates of late severe periventricular/intraventricular hemorrhage in the dobutamine group. At 3 years, infants in the dopamine group had significantly more disability and a lower Griffiths General Quotient. At the latest time measured, however, combined rates of death or disability were similar.

CONCLUSIONS. Early low superior vena cava flow was associated with substantial rates of death, morbidity, and developmental impairments. No difference was found in combined rates of death and disability for infants assigned randomly to dopamine or dobutamine.

Key Words: premature infant • developmental disability • cardiac output • dopamine • dobutamine

Abbreviations: GQ—General Quotient • OR—odds ratio • PIVH—periventricular/intraventricular hemorrhage • SBF—systemic blood flow • SGA—small for gestational age • SVC—superior vena cava • CI—confidence interval

Accepted Mar 27, 2007.


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