Dobutamine Dosing in Neonates and Pediatric Patients
The starting dose of dobutamine for neonates and pediatric patients is 2-20 μg/kg/min, with a typical starting dose of 2-5 μg/kg/min, titrated to the desired clinical effect. 1
Dosing Guidelines
Neonates
- Starting dose: 2-5 μg/kg/min
- Dose range: 2-20 μg/kg/min
- Titration: Gradually increase based on clinical response
Pediatric Patients
- Starting dose: 2-5 μg/kg/min
- Dose range: 2-20 μg/kg/min
- Maximum dose: Generally not exceeding 20 μg/kg/min
Administration Protocol
Preparation
- Dobutamine must be diluted in an IV container to at least a 50-mL solution using compatible IV fluids 2
- Compatible solutions include:
- 5% Dextrose Injection
- 0.9% Sodium Chloride Injection
- Other compatible crystalloids
Titration Process
- Start at the lower end of the dosing range (2-5 μg/kg/min)
- Titrate at intervals of a few minutes
- Guide titration by monitoring:
- Systemic blood pressure
- Heart rate
- Urine output
- Cardiac output (when possible)
- Central venous pressure (when possible)
- Pulmonary capillary wedge pressure (when possible) 2
Clinical Considerations
Indications
- Cardiogenic shock
- Congestive heart failure
- Low cardiac output states requiring inotropic support 1
Monitoring Requirements
- Continuous ECG monitoring is mandatory
- Blood pressure checks every 5-15 minutes during initiation and titration
- Regular assessment of:
- Cardiac output
- Tissue perfusion
- Central venous pressure (when possible) 3
Potential Adverse Effects
- Tachyarrhythmias/ectopic beats
- Hypotension
- Hypertension
- Extravascular administration can result in severe skin injury 1
Special Considerations for Neonates
- Neonates may have a diminished inotropic response compared to older children due to maturational differences in norepinephrine stores 4
- Clearance varies widely in the pediatric population depending on age:
- Full-term neonates: ~2 minutes elimination half-life
- Preterm infants: May be as long as 4-5 minutes elimination half-life 4
Important Caveats
Extravasation Risk: Monitor IV site regularly. If extravasation occurs, 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 may help counteract dermal vasoconstriction 1
Pharmacokinetic Variability: Wide variability in hemodynamic responses and clearance kinetics indicates that dobutamine infusions must be titrated individually 5
Incompatibilities: Do not add dobutamine to 5% Sodium Bicarbonate Injection or any strongly alkaline solution. Do not mix with other drugs in the same solution 2
Duration of Therapy: Prolonged infusion (>24-48h) is associated with tolerance and partial loss of hemodynamic effects 3
Weaning: Gradual tapering is recommended to avoid rebound hypotension 3
By following these dosing guidelines and monitoring parameters, dobutamine can be safely and effectively administered to neonatal and pediatric patients requiring inotropic support.