Pharmacology Review

During the past 2 decades, dopamine has become the most frequently used sympathomimetic amine in the treatment of neonatal shock. The observations that severe and prolonged hypotension may result in the development of irreversible shock, which is associated with increased mortality and central nervous system morbidity, form the rationale behind the early use of dopamine and other sympathomimetic amines in neonates if volume administration fails. However, although cautious volume administration and the early use of dopamine are effective in improving the cardiovascular status and renal function in most neonates who have hypotension, there is only indirect evidence that the use of dopamine (and the other sympathomimetic amines) in the management of neonatal shock improves mortality and morbidity. Recent advances in understanding of the pathophysiology of neonatal shock and the developmentally regulated mechanisms of dopamine action have led to more sophisticated use of this drug. Yet, limitations in the ability to assess accurately tissue perfusion at the bedside present challenges to management of neonatal shock, especially in the very preterm neonate during the immediate postnatal period. Furthermore, although recent studies have shed light on the effects of dopamine on regional organ blood flow in the neonate, there is very little evidence on the effects of dopamine (and the other sympathomimetic amines) on tissue oxygen delivery and consumption. Bearing these limitations in mind, we review the mechanisms of action and pharmacokinetics of dopamine and discuss the cardiovascular, renal, and neuroendocrine effects of the drug. Additionally, we examine the clinical evidence supporting and challenging the use of this sympathomimetic amine in the treatment of neonatal cardiovascular compromise. Dopamine, an endogenous catecholamine and the precursor of epinephrine and norepinephrine, plays an important physiologic role in the regulation of cardiovascular, renal, neuroendocrine, and central nervous system functions. Therefore, when used for its cardiovascular and renal …