This study analyzed data from over 54,000 pediatric patients with heart failure who received intravenous inotropic and/or vasoconstrictive medications. It found that the use of dobutamine and dopamine has decreased in recent years while other medications like milrinone have increased. Dobutamine and norepinephrine were associated with the highest odds ratios of inpatient mortality compared to patients who did not receive intravenous medications. The study concludes that dobutamine and dopamine have fallen out of favor for use in pediatric heart failure patients.

1. The use of inotropic and vasoconstrictor medications in
the pediatric heart failure population
Raysa Morales-Demori, MD; Marc Anders, MD
Department of Pediatrics. Section of Critical Care
Baylor College of Medicine. Texas Children’s Hospital

2. 2
Background
Inotropes and vasoconstrictor medications are frequently used
in the pediatric heart failure population for the acute and
chronic management in this condition; however certain
agents, such as Dobutamine, have been associated with
increased inpatient mortality
King, et al. Pharmacotherapy. 2017

3. 3
Objective
To describe the demographics and outcomes of pediatric
patients with heart failure (HF) who received intravenous
continuous inotropic and/or vasoconstrictive medications [IV
meds]

4. 4
Methods
• Type of study: Retrospective cohort study
• Database: Pediatric Health Information System
• Study period: 01/2004 – 12/2017
• Inclusion criteria:
• All patients ≤ 21 year
• Heart failure diagnoses ICD-9 (428.xx) or ICD-10 (i50.xx)

5. 5
Results
IVmeds +
N= 54,695
Male, N (%) 28,989 (53%)
Age, median in months (IQR 25-75) 6.2 (1.8-55.5)
Race/ethnicity:
White Non-Hispanics, N (%) 28,548 (52%)
Hispanics, N (%) 11,162 (20%)
African American Non-Hispanics, N(%) 7,037 (13%)
Congenital Heart disease, N (%) 42,458 (78%)
Mortality risk
Minor, N (%) 3,896 (7%)
Moderate, N (%) 13,838 (25%)
Major, N (%) 23,839 (44%)
Extreme, N (%) 12,983 (24%)

6. 6
Inotropics use trend
0%
10%
20%
30%
40%
50%
60%
70%
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Percentageofuse/admissionsperyear
Dopamine Dobutamine Epinephrine Isoproterenol Milrinone

7. 7
Vasoconstrictors use trend
0%
5%
10%
15%
20%
25%
30%
35%
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Percentageofuse/admissionsperyear
Phenylephrine Vasopressin Norepinephrine Ephedrine

8. 8
Odds ratio of death by inotropic
OR of death by inotropic agent when compared to death without IVmeds use
0
2
4
6
8
10
12
14
16
18
Milrinone Epinephrine Dobutamine Dopamine Isoproterenol
OR(CI95%)

9. 9
Odds ratio of death by vasoconstrictor
OR of death by vasoconstrictor agent when compared to death without IVmeds use
0
5
10
15
20
25
30
35
Norepinephrine Phenylephrine Ephedrine Vasopressin
OR(CI95%)

10. 10
Conclusions
• Dobutamine and Dopamine use has fallen out of favor in
the pediatric HF population
• Dobutamine and Norepinephrine have the highest odds
ratio of inpatient mortality