What is the protocol for preparing a dopamine drip for an infant?

Dopamine Drip Preparation for Infants

The recommended method for preparing a dopamine drip for an infant is to use the "rule of 6": multiply 0.6 × body weight (kg) to determine the number of milligrams of dopamine to dilute in 100 mL of saline; then 1 mL/h delivers 0.1 mcg/kg/min. 1

Standard Preparation Method

• Use the "rule of 6" formula: 0.6 × weight (kg) = mg of dopamine to add to 100 mL of saline 1
• For example, for a 5 kg infant: 0.6 × 5 = 3 mg dopamine in 100 mL saline
• This standardized concentration allows for precise dosing where 1 mL/hr = 0.1 mcg/kg/min 1
• Alternatively, prepare a standard solution of 400 mg dopamine in 500 mL D5W for larger infants or when higher concentrations are needed 1, 2

Administration Guidelines

• Administer only via infusion pump, preferably a volumetric pump - never by gravity drip 2
• Infuse into a large vein whenever possible (antecubital fossa preferred over dorsum of hand or ankle) to prevent infiltration 2
• Typical dosing range for infants: 2-20 mcg/kg/min, titrated to desired effect 1, 2
• Dosing effects are concentration-dependent 1:
  • Low doses (<5 mcg/kg/min): Primarily dopaminergic effects (renal and mesenteric vasodilation)
  • Intermediate doses (5-10 mcg/kg/min): β-adrenergic effects (increased cardiac contractility)
  • Higher doses (>10 mcg/kg/min): α-adrenergic effects (peripheral vasoconstriction)

Critical Safety Considerations

• Do NOT administer if solution is darker than slightly yellow or discolored in any way 2
• Do NOT add sodium bicarbonate or other alkalinizing substances as dopamine is inactivated in alkaline solution 2
• Cover the bottle, burette, or syringe pump with protective foil to avoid breakdown by light (IV tubing does not need protection) 3
• Monitor blood pressure continuously, preferably with an arterial line during administration 3
• Exercise extreme caution to avoid accidental flushing/bolus injection of the IV line 3
• Watch for extravasation which can cause severe skin injury; phentolamine (0.1-0.2 mg/kg) injected intradermally at extravasation site may counteract dermal vasoconstriction 3

Monitoring During Infusion

• Continuous monitoring of vital signs including blood pressure, heart rate, and ECG is essential 1
• Assess peripheral perfusion regularly 1
• Monitor urine output - diminishing urine flow may indicate need to reduce dosage 2
• Watch for tachycardia or development of new dysrhythmias which may necessitate decreasing or temporarily suspending the dosage 2, 4

Special Considerations for Neonates

• Neonates may have diminished inotropic response compared to older children due to maturational differences in norepinephrine stores 4
• Clearance varies widely in the pediatric population - elimination half-life is approximately 2 minutes in full-term neonates but may be as long as 4-5 minutes in preterm infants 4
• Preterm infants may require higher initial doses (≥10 mcg/kg/min) to achieve blood pressure response 5
• Preterm infants demonstrate decreased metabolic clearance rate of dopamine, which should be considered when determining dosing 6