Key result
Dopamine shows no benefit over direct-acting catecholamines for shock reversal and increases heart rate.
Why the study?
Although dopamine is commonly used first-line for neonatal fluid-refractory septic shock and direct-acting catecholamines may offer pharmacologic benefits, the most effective initial vasoactive strategy remains unclear.
Does dopamine improve shock reversal compared to direct-acting catecholamines (epinephrine or norepinephrine) as initial vasoactive therapy in neonates with fluid-refractory septic shock?
Meta-Analysis (n=250)
Does dopamine improve shock reversal compared to direct-acting catecholamines (epinephrine or norepinephrine) as initial vasoactive therapy in neonates with fluid-refractory septic shock?
Answers are grounded in this paper and cite their sources.
In neonates with fluid-refractory septic shock, first-line dopamine, epinephrine, and norepinephrine demonstrate similar efficacy for shock reversal and safety profiles, though dopamine causes a significantly greater increase in heart rate.
Background: Neonatal fluid-refractory septic shock remains a life-threatening condition associated with substantial mortality. Although dopamine has long been used as a first-line vasoactive agent in neonatal practice, direct-acting catecholamines, including epinephrine and norepinephrine, may provide potential pharmacologic benefits. However, the most effective initial vasoactive strategy in this setting remains unclear. Methods: We performed a systematic review and meta-analysis of randomized controlled trials evaluating dopamine versus epinephrine or norepinephrine as first-line vasoactive treatment in neonates with fluid-refractory septic shock. A comprehensive search of PubMed, Scopus, Web of Science, and the Cochrane Library was conducted from database inception through April 2026. Pooled estimates were calculated using random-effects models and reported as risk ratios or mean differences with corresponding 95% confidence intervals. Results: Four randomized controlled trials, including 250 neonates, met the eligibility criteria. No significant differences were found between dopamine and direct-acting catecholamines in terms of shock reversal (RR=0.92, 95% CI [0.66–1.29]), achievement of a capillary refill time (CRT) ≤2 seconds, duration of shock, requirement for additional vasoactive agents, or changes in systolic, diastolic, and mean arterial blood pressure. Likewise, safety outcomes, including necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity, did not differ significantly between treatment groups. In contrast, dopamine was associated with a significantly greater increase in heart rate (MD = 9.31, 95% CI [0.73–17.88]). Conclusions: Dopamine, epinephrine, and norepinephrine showed similar efficacy and safety profiles when used as first-line vasoactive therapy for neonatal fluid-refractory septic shock. Nevertheless, dopamine was associated with a greater increase in heart rate. Further large-scale multicenter randomized trials are warranted to identify the optimal first-line vasoactive agent in this population.
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Talkhan et al. (2026) conducted a meta-analysis in Neonatal fluid-refractory septic shock (n=250). Dopamine vs. Direct-acting catecholamines (epinephrine or norepinephrine) was evaluated on Shock reversal (RR 0.92, 95% CI 0.66-1.29). Dopamine showed no significant difference in shock reversal vs direct-acting catecholamines (RR 0.92, 95% CI 0.66-1.29), but caused a greater increase in heart rate (MD 9.31, 95% CI 0.73-17.88).
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