Inotrope Use among Extremely Preterm Infants in Canadian Neonatal Intensive Care Units: Variation and Outcomes

Abstract

Objective To compare neonatal outcomes between infants who received inotropes and those who did not, and identify variation in inotrope use.

Study Design Retrospective review of data from neonates < 29 weeks gestation collected by the Canadian Neonatal Network during 2003 to 2010. After controlling for confounders and maternal/infant characteristics, rates of mortality and major morbidity were compared between those who received inotropes on days 1 and 3 of admission and those who did not. Rate of inotrope use was compared between sites.

Results Inotropes were administered to 772 (10%) of the 7,913 neonates. Infants who received inotropes had significantly higher illness severity, surfactant use, and need for mechanical ventilation. Inotrope use was also associated with significantly higher rates of mortality (adjusted odds ratio [AOR] = 2.05 [1.64, 2.57]), retinopathy of prematurity (AOR = 2.04 [1.54, 2.71]), intraventricular hemorrhage (AOR = 1.59 [1.29, 1.93]), bronchopulmonary dysplasia (AOR = 1.38 [1.11, 1.72]), and necrotizing enterocolitis (AOR = 2.06 [1.59, 2.67]). Rates of inotrope use varied significantly between participating sites (0–36%; AOR = 0 [0, 0.1]–7.7 [2.9, 21]).

Conclusion Risk of mortality and major morbidities were significantly higher in neonates who received inotropes. Inotrope use varied significantly among Canadian neonatal intensive care units.

Keywords

infant - premature - inotrope - mortality - morbidity - variation

Site Investigators of the Canadian Neonatal Network

Prakesh S Shah (Director, Canadian Neonatal Network, Toronto, Ontario); Wayne Andrews (Janeway Childrenʼs Health and Rehabilitation Centre, St Johnʼs, Newfoundland and Labrador); Keith Barrington (Sainte Justine Hospital, Montreal, Quebec); Wendy Yee (Foothills Medical Centre, Calgary, Alberta); Barbara Bullied (Everett Chalmers Hospital, Fredericton, New Brunswick); Rody Canning (Moncton Hospital, Moncton, New Brunswick); Ruben Alvaro (St. Boniface General Hospital, Winnipeg, Manitoba); Kimberly Dow (Kingston General Hospital, Kingston, Ontario); Michael Dunn (Sunnybrook Health Sciences Centre, Toronto, Ontario); Adele Harrison (Victoria General Hospital, Victoria, British Columbia); Kyong-Soon Lee (The Hospital for Sick Children, Toronto, Ontario); Zarin Kalapesi (Regina General Hospital, Regina, Saskatchewan); Lajos Kovacs (Jewish General Hospital, Montreal, Quebec); Orlando da Silva (St. Josephʼs Health Centre; London, Ontario); Douglas D. McMillan (IWK Health Centre, Halifax, Nova Scotia); Prakesh Shah (Mount Sinai Hospital, Toronto, Ontario); Cecil Ojah (St. John Regional Hospital, St. John, New Brunswick); Abraham Peliowski/Khalid Aziz (Royal Alexandra Hospital, Edmonton, Alberta); Bruno Piedboeuf (Centre hospitalier universitaire de Québec, Sainte Foy, Quebec); Patricia Riley (Montreal Children's Hospital, Montreal, Quebec); Daniel Faucher (Royal Victoria Hospital, Montreal, Quebec); Nicole Rouvinez-Bouali (Children's Hospital of Eastern Ontario, Ottawa, Ontario); Koravangattu Sankaran (Royal University Hospital, Saskatoon, Saskatchewan); Mary Seshia (Health Sciences Centre, Winnipeg, Manitoba); Sandesh Shivananda (Hamilton Health Sciences Centre, Hamilton, Ontario); Zenon Cieslak (Royal Columbian Hospital, New Westminster, British Columbia); Anne Synnes (Children's and Women's Health Centre of British Columbia, Vancouver, British Columbia); Herve Walti (Centre Hospitalier Universitaire de Sherbrooke, Fleurimont, Quebec), and Shoo K. Lee, (Chairman, Canadian Neonatal Network, Toronto, Ontario).

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