Benefits of high-dose dopamine in experimental neonatal septic shock.

The benefits of dopamine resuscitation in neonatal shock are in doubt. To evaluate dopamine's effectiveness on regional perfusion and survival, neonatal pigs were subjected to fecal Escherichia coli peritonitis-induced septic shock and were randomly divided into equal groups. Control animals (Group I) were not resuscitated with dopamine. Dopamine resuscitation, as a continuous infusion of 5 micrograms/kg/min (Group II), 50 micrograms/kg/min (Group III), or 200 micrograms/kg/min (Group IV), began when cardiac output dropped 20% below baseline. Radiolabeled microspheres were used to assess regional perfusion. Survival was defined as no hemodynamic compromise at 24 hr. Increased survival time correlated with sustained increases in cardiac output and blood pressure in Group III, which were not observed in the other groups. Significant changes in multiorgan regional perfusion were also observed in Group III and correlate with the improved survival. These data suggest that higher than usual doses of dopamine may be beneficial in neonates with peritonitis-induced septic shock.