Dopamine vs. Norepinephrine for Hypotension in Very Preterm Infants With Late-onset Sepsis

Recruiting now

Conditions studied: Late-Onset Neonatal Sepsis, Extreme Prematurity, Neonatal Hypotension

In brief

Fluid-unresponsive hypotension needing cardiotropic drug treatment is a serious complication in very preterm neonates with suspected late-onset sepsis (LOS; defined as culture positive or negative bloodstream infection or necrotizing enterocolitis occurring \>48 hours of age). In Canada, \~250 very preterm neonates receive cardiotropic drugs for LOS related fluid-unresponsive hypotension every year; of these \~35-40% die. Unlike for adult patients, there is little evidence to inform practice. While several medications are used by clinicians, the most frequently used medications are Dopamine (DA) and Norepinephrine (NE). However, their relative impact on patient outcomes and safety is not known resulting in significant uncertainty and inter- and intra-unit variability in practice. Conducting large randomized trials in this subpopulation can be operationally challenging and expensive. Comparative effectiveness research (CER), is a feasible alternative which can generate high-quality real-world evidence using real-world data, by comparing the impact of different clinical practices. Aim: To conduct an international CER study, using a pragmatic clinical trial design, in conjunction with the existing infrastructure of the Canadian Neonatal Network to identify the optimal management of hypotension in very preterm neonates with suspected LOS. Objective: To compare the relative effectiveness and safety of pharmacologically equivalent dosages of DA versus NE for primary pharmacotherapy for fluid-unresponsive hypotension in preterm infants born ≤ 32 weeks gestational age with suspected LOS. Hypothesis: Primary treatment with NE will be associated with a lower mortality Methods: This CER project will compare management approach at the unit-level allowing inclusion of all eligible patients admitted during the study period. 16 centers in Canada, 2 centers in Ireland, 1 center in each of Israel, Spain and the UK, and 6 centers in the United States have agreed to standardize their practice. All eligible patients deemed circulatory insufficient will receive fluid therapy (minimum 10-20 cc/kg). If hypotension remains unresolved: Dopamine Units: start at 5mics/kg/min, increase every 16-30 minutes by 5 mics/kg/min to a maximum dose of 15 mics/kg/min or adequate response Norepinephrine Units: start at 0.05 mics/kg/min, increase every 16-30 minutes by 0.05 mics/kg/min to maximum dose of 0.15/mics/kg/min or adequate response

Key facts

Study ID

NCT05347238

Run by

Mount Sinai Hospital, Canada

People needed

550

Starts

2023-02-06

Expected to finish

2027-03-31

Last updated by the study team

2025-07-08

Who can join

Age: 0 and older, up to 1. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• ≤32 weeks gestational age and > 48 hours of life
• Receiving primary vasopressor therapy with Dopamine or Norepinephrine in the context of suspected late-onset sepsis or necrotizing enterocolitis with systemic hypotension (defined as: culture positive or negative bloodstream infection)

You may not qualify if…

• Known chromosomal or genetic anomalies
• Receiving primary therapy with agents other than Dopamine or Norepinephrine

Where it is running

• La Paz University Hospital — Madrid, Spain (enrolling)
• Dayton Children's Hospital — Dayton, Ohio, United States (enrolling)
• Methodist Healthcare — San Antonio, Texas, United States (enrolling)
• Foothill's Medical Centre — Calgary, Alberta, Canada (enrolling)
• BC Women's Hospital — Vancouver, British Columbia, Canada (enrolling)
• Victoria General Hospital — Victoria, British Columbia, Canada (enrolling)
• Montreal Children's Hospital — Montreal, Quebec, Canada (enrolling)
• University Cork College — Cork, Ireland (enrolling)
• Shamir Medical Center — Be’er Ya‘aqov, Israel (enrolling)
• Winnipeg Health Sciences Centre — Winnipeg, Manitoba, Canada (enrolling)
• IWK Health Centre — Halifax, Nova Scotia, Canada (enrolling)
• McMaster Children's Hospital — Hamilton, Ontario, Canada (enrolling)
• London Health Sciences Centre — London, Ontario, Canada (enrolling)
• Children's Hospital of Eastern Ontario — Ottawa, Ontario, Canada (enrolling)
• Hospital for Sick Children — Toronto, Ontario, Canada (enrolling)
• Mount Sinai Hospital — Toronto, Ontario, Canada (enrolling)
• Sunnybrook Health Sciences Centre — Toronto, Ontario, Canada (enrolling)
• Windsor Regional Hospital — Windsor, Ontario, Canada (enrolling)
• CHU Sainte- Justine — Montreal, Quebec, Canada (enrolling)
• Jewish General Hospital — Montreal, Quebec, Canada (enrolling)
• St.Boniface Hospital — Winnipeg, Manitoba, Canada
• Banner-University Medical Center Phoenix — Phoenix, Arizona, United States
• Coombe Women & Infants University Hospital — Dublin, Ireland

Full record on ClinicalTrials.gov

Trial information comes from ClinicalTrials.gov and is refreshed daily. TrialsForMe does not provide medical care and does not run the studies it lists.