Recommended Dosage of Dopamine in Neonates and Pediatric Patients
The recommended dose of dopamine for neonates and pediatric patients is 2-20 mcg/kg/min administered as an IV infusion, titrated to the desired clinical effect based on the patient's hemodynamic response. 1
Dosing Guidelines by Age Group and Clinical Indication
Neonates
- Starting dose: 2-5 mcg/kg/min IV infusion
- Dose range: 2-20 mcg/kg/min
- Titration: Increase gradually based on clinical response
- Special considerations: Neonates may have diminished inotropic response compared to older children due to maturational differences in norepinephrine stores 2
Infants and Children
- Starting dose: 2-5 mcg/kg/min IV infusion
- Dose range: 2-20 mcg/kg/min
- Titration: Increase gradually based on clinical response
Dose-Dependent Effects
Dopamine produces different physiological effects at different dosages:
- Low dose (1-5 mcg/kg/min): Primarily stimulates dopaminergic receptors, causing renal and mesenteric vasodilation 1
- Intermediate dose (5-10 mcg/kg/min): Stimulates both dopaminergic and β-adrenergic receptors, providing inotropic support
- High dose (10-20 mcg/kg/min): α-adrenergic effects predominate, causing peripheral vasoconstriction 1
Clinical Applications
Cardiogenic Shock/Congestive Heart Failure
- IV infusion: 2-20 mcg/kg/min, titrated to desired clinical effect 1
- Monitor for tachyarrhythmias, ectopic beats, hypotension, and hypertension
Distributive Shock (including septic shock)
- IV infusion: 2-20 mcg/kg/min, titrated to desired clinical effect 1
- For fluid-refractory shock: Begin dopamine up to 10 mcg/kg/min 1
Preparation Guidelines
For pediatric patients, the "Rule of 6" can be used for preparation:
- 6 × weight (kg) = mg of dopamine to add to 100 mL of solution
- With this preparation, 1 mL/hr delivers 1 mcg/kg/min 1
Alternative formula:
- Infusion rate (mL/h) = [Weight (kg) × Dose (mcg/kg/min) × 60 (min/hour)] / Concentration (mcg/mL) 1
Monitoring and Precautions
Required Monitoring
- Continuous cardiac monitoring
- Frequent blood pressure measurements (preferably arterial line for higher doses)
- Urine output
- Peripheral perfusion
- Infusion site for signs of extravasation
Adverse Effects
- Tachycardia and cardiac arrhythmias (most common)
- Hypertension at higher doses
- Peripheral, renal, and splanchnic vasoconstriction and ischemia at doses approaching 20 mcg/kg/min 1
- Tissue necrosis with extravasation
Extravasation Management
If extravasation occurs:
- Stop infusion immediately
- Consider phentolamine (0.1-0.2 mg/kg up to 10 mg diluted in 10 mL of 0.9% sodium chloride) injected intradermally at the extravasation site to counteract dermal vasoconstriction 1
Important Clinical Considerations
Central line administration: Dopamine should ideally be administered through a central venous catheter, especially at higher doses, to minimize the risk of extravasation.
Efficacy limitations: In neonates, dopamine may have reduced efficacy due to immature sympathetic innervation and decreased norepinephrine stores 2.
Renal function: Despite traditional belief, there is insufficient evidence that low-dose dopamine (< 5 mcg/kg/min) prevents or treats acute kidney injury in neonates 3, 4.
Hypotension definition by age: When treating hypotension, consider age-specific thresholds 1:
- Term neonates (0-28 days): < 60 mmHg systolic
- Infants (1-12 months): < 70 mmHg systolic
- Children (1-10 years): < 70 + (2 × age in years) mmHg systolic
- Beyond 10 years: < 90 mmHg systolic
Alternative agents: If dopamine is ineffective, consider epinephrine (0.05-0.3 mcg/kg/min) for neonates 1 or norepinephrine (0.1-2 mcg/kg/min) for children with distributive shock 1.
By following these dosing guidelines and monitoring parameters, dopamine can be safely and effectively used to support cardiovascular function in neonates and pediatric patients with various shock states and cardiac dysfunction.