Pharmacological Hypotensive Treatment in Very Preterm Newborns: Systematic Review and Meta‐Analysis of Randomised Controlled Trials

Aims To evaluate the efficacy, safety and long‐term effects of pharmacological options for hypotension in very preterm newborns through a meta‐analysis of available randomized controlled trials ( RCTs ). Methods RCTs published up to March 2025 involving newborns born at ≤ 30 weeks of gestational age or ≤ 1500 g at birth, treated with any pharmacological intervention for hypotension were included. Results We analysed 12 RCTs (enrolling 539 newborns). None of the drugs analysed improve survival or clinical outcome. Dopamine ( p = 0.0008, I 2 = 28%, p = 0.24, OR 4.53 95% CI 1.87–11.00) and hydrocortisone ( p = 0.008, OR 9.31 95% CI 1.78–48.72, heterogeneity not applicable) appeared effective in resolving hypotension in very preterm newborns, compared to placebo. However, dopamine increased the risk of intraventricular haemorrhage by 3.47 times ( p = 0.03, I 2 = 0%, p = 0.75, 95% CI 1.10–10.93) compared with placebo. Epinephrine ( p = 0.010, OR 0.16 95% CI 0.04–0.64, heterogeneity not applicable) and hydrocortisone ( p = 0.03, OR 4.23 95% CI 1.11–16.17, heterogeneity not applicable) were associated with a higher risk of hyperglycemia when compared to dobutamine and placebo, respectively. Conclusion Pharmacological treatment of neonatal hypotension may improve blood pressure without positive effects on mortality and neurodevelopment in very preterm newborns. However, associated adverse effects such as intraventricular haemorrhage and hyperglycemia appear relevant. Trial Registration PROSPERO Registration number: CRD42024619749