An evaluation of off-label fenoldopam use in the neonatal intensive care unit

We analyzed the effect of off-label fenoldopam (FDM) therapy on electrolyte balance, renal function, blood pressure, and urinary output in neonatal patients. We performed a retrospective review of 22 neonates treated with FDM in two neonatal intensive care units. Primary outcome compared physiological status 24 hours before FDM therapy to the first 24 hours of FDM therapy. Electrolytes, blood urea nitrogen (BUN), creatinine, fluid intake, respiratory support, blood pressure, and heart rate were also compared. FDM was used to treat oliguria and anasarca. Seven infants were supported with extracorporeal membrane oxygenation. Gestation ranged 24 to 39 weeks (median 37) and postnatal age, 1 to 89 days (median 10). FDM dose increased over time (median initial dose 0.10 microg/kg/min versus 0.20 at 48 hours). FDM therapy had no effect on serum creatinine, electrolytes, or cardiopulmonary function but was associated with a significant increase in BUN ( P = 0.008). Urine output did not increase significantly for the group as a whole (paired T test) but did significantly increase during the initial 24-hour infusion among oliguric infants. Low-dose FDM did not improve urine output in critically ill neonates as a whole. There were no apparent adverse cardiopulmonary or metabolic effects from FDM use in this limited population. Future FDM use in the context of a randomized prospective trial appears warranted in the early management of infants with oliguria.