Epinefrina ou Dopamina: qual a melhor droga vasoativa no choque séptico neonatal? – uma revisão sistemática

• Autor(a) principal: Pozza , Ariadne Cristine
• Data de Publicação: 2021
• Outros Autores: Corti, Eduarda Luísa Rocha, Teixeira, Heloísa Moro, Cordeiro, Maria Victória Gutierrez, Silveira, Mariane Barbieri da
• Tipo de documento: Trabalho de conclusão de curso
• Idioma: por
• Título da fonte: Repositório do Centro Universitário Braz Cubas
• Texto Completo: https://repositorio.cruzeirodosul.edu.br/handle/123456789/3831
• topic: Epinefrina; Dopamina; Choque neonatal; Droga vasoativa; Prematuro; CNPQ::CIENCIAS DA SAUDE::MEDICINA

Introduction: Neonatal death is still a growing contribution to overall infant mortality in children under 5 years of age, representing about 73% of postnatal deaths in the world. Septic shock is among the main etiologies in this age group. Early identification of the condition and its pathophysiology are determining factors for proper management. In this context, there are two drug therapies for shock reversal: dopamine (the most used vasopressor) and epinephrine (inotropic and vasopressor). Method: This is a systematic review using the PRISMA method. The keywords used were: preterm; hypotension; vasoactive medications; neonatal shock; epinephrine and dopamine, in the Lilacs, PubMed and SciELO databases, for a period of 10 years, based on the research question PICO: ´´in a neonatal population, what is the best drug to treat shock? ``. After, was performed an exclusion of duplicates and publications that did not meet the inclusion criteria – cohort studies, case-control, randomized clinical trials or double-blind clinical trials comparing the use of epinephrine and dopamine in neonatal shock in preterm infants. Of these, the variables analyzed were: gestational age, birth weight, dose of epinephrine, dose of dopamine, time of use of both drugs, systolic blood pressure (SBP) at 0 and 45 minutes and outcome. Results: From the combinations of keywords, 2,485 articles were found. After filtering, only 1 article met the eligibility criteria. In this study, 40 neonates with gestational age between 30 and 32 weeks and birth weight between 1100g and 1200g with septic shock refractory to fluid replacement were randomized to receive epinephrine or dopamine. After 45 minutes, 5 neonates in the epinephrine group and 6 in the dopamine group achieved shock reversal. 10 and 6 neonates in the respective groups achieved hemodynamic stability (>120min without an increase in vasoactive drug). Mean blood pressure ranged between 32 ± 15 in the epinephrine group and 32 ± 12 in the dopamine group. The main outcomes were: intraventricular hemorrhage, necrotizing enterocolitis, retinopathy of prematurity and bronchopulmonary dysplasia. Mortality reached 70% in the epinephrine group and 80% in the dopamine group. Conclusion: Both epinephrine and dopamine demonstrated similar safety and efficacy on blood pressure, however, epinephrine had transient effects on lactate metabolism. For this reason and due to the greater number of studies involving dopamine, the literature indicates this drug as the first line of treatment for neonatal shock.