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Updated: Jul 13, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Low superior vena cava flow and effect of inotropes on neurodevelopment to 3 years in preterm infants
David A Osborn1, Nick Evans, Martin Kluckow
1Royal Prince Alfred Newborn Care, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia. david.osborn@email.cs.nsw.gov.au
Insights
Early low systemic blood flow in preterm infants predicts death and developmental issues. While dobutamine showed some benefits in reducing hemorrhage, both dobutamine and dopamine had similar overall death or disability rates at 3 years.
Area of Science:
- Neonatalogy
- Pediatric Cardiology
- Developmental Pediatrics
Background:
- Preterm infants often experience low systemic blood flow, a critical indicator of cardiovascular compromise.
- Superior vena cava (SVC) flow measurement is a key non-invasive method to assess systemic blood flow in neonates.
- Understanding the long-term neurodevelopmental outcomes associated with early low SVC flow is crucial for clinical management.
Purpose of the Study:
- To evaluate the 1- and 3-year outcomes of preterm infants with low systemic blood flow.
- To compare the efficacy of dobutamine versus dopamine in treating low systemic blood flow in this population.
Main Methods:
- Echocardiographic measurement of SVC flow in 128 infants born at <30 weeks gestation.
- Randomized assignment to dobutamine or dopamine for 42 infants with low SVC flow (<41 mL/kg per minute).
- Blinded neurodevelopmental assessments at 1 and 3 years corrected age for surviving infants.
Main Results:
- Low SVC flow, lower gestational age, and low Apgar scores predicted death at 3 years.
- Low SVC flow was associated with significant reductions in neurodevelopmental quotients, particularly in personal-social, hearing/speech, and performance domains.
- While dobutamine reduced severe periventricular/intraventricular hemorrhage, no significant differences in combined death or disability rates were observed between dobutamine and dopamine groups at 3 years.
Conclusions:
- Early low SVC flow in preterm infants is linked to increased mortality, morbidity, and developmental impairments.
- Neither dobutamine nor dopamine demonstrated a significant difference in the combined rates of death and disability at 3 years.
- Dobutamine may offer a potential benefit in reducing severe intraventricular hemorrhage rates.
Objective:
The goal was to report the 1- and 3-year outcomes of preterm infants with low systemic blood flow in the first day and the effect of dobutamine versus dopamine for treatment of low systemic blood flow.
Methods:
A cohort of 128 infants born at <30 weeks of gestation underwent echocardiographic measurement of superior vena cava flow at 3, 10, and 24 hours of age. Forty-two infants with low superior vena cava flow (<41 mL/kg per minute) were assigned randomly to dobutamine or dopamine. Surviving infants underwent blinded neurodevelopmental assessments at corrected ages of 1 and 3 years.
Results:
Seventy-six of 87 surviving infants were seen at 1 year and 67 at 3 years. Forty-four infants had low superior vena cava flow. At 3 years, with adjustment for perinatal risk factors, death was predicted by low superior vena cava flow, lower gestational age, and low 5-minute Apgar score. Substantial reductions in the Griffiths General Quotient were associated with low superior vena cava flow and birth weight of <10th percentile. Infants with low flow had significant reductions in personal-social, hearing and speech, and performance subscales. Death or disability at 3 years was predicted by low superior vena cava flow and lower gestational age. For infants treated with inotropes, no significant differences were found in clinical outcomes, except for reduced rates of late severe periventricular/intraventricular hemorrhage in the dobutamine group. At 3 years, infants in the dopamine group had significantly more disability and a lower Griffiths General Quotient. At the latest time measured, however, combined rates of death or disability were similar.
Conclusions:
Early low superior vena cava flow was associated with substantial rates of death, morbidity, and developmental impairments. No difference was found in combined rates of death and disability for infants assigned randomly to dopamine or dobutamine.
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