Dopamine in lage dosis in de neonatale en pediatrische intensive care: Is er nog een indicatie?

Dopamine is an endogenous catecholamine, an immediate precursor of noradrenaline. Low-dose dopamine (< 4 μ/kg/min)(LDD) has widely been used in intensive care for its supposed renal protective effects in adults, children and neonates as well. In this review we discuss the physiology of renal dopamine and dopamine receptors. In healthy adult volunteers LDD increases renal blood flow and sodium excretion and enhances urine volume. In critically ill adults the use of LDD remains controversial as unequivocal evidence of improvement in renal function, i.e. an increase in creatinine clearance or glomerular filtration rate, has not been published to date. LDD is also commonly used in neonatal and pediatric intensive care units for the same reasons. As indicated by the results of our survey of current use in the Netherlands, almost all units used LDD more or less regularly. We reviewed the literature in this age group, but we found only one randomised controlled trial, in which no statistically significant effect of LDD on renal function and urine volume is reported. All other studies were non-randomised and similarly inconclusive. In view of the adverse effects, the use of LDD in neonatal and paediatric patients should be reconsidered until a placebo-controlled trial yields new evidence.