Improvement in recognition, monitoring and management has changed the outlook in cases of shock. A variety of pathophysiological changes have been recognized to depress the cardiovascular function in septic shock. Administration of fluids and if necessary, inotropes are useful interventions to improve circulatory status. In this observational study, we narrate our experience of using adrenaline in shock due to sepsis.

The subjects of this study are 9 babies who had signs and symptoms of sepsis and their blood cultures were positive. Shock was diagnosed in presence of clinical signs like tachycardia, weak pulsations and cool peri-pheries associated with a drop in mean arterial pressure (MAP) by more than 20% of earlier reading (taken as part of routine monitoring). Blood pressure was recorded by Pacetech, Model 800 II, non-invasive blood pressure monitor. Adrenaline was administered in a dose of 0.2 mg/kg/min when response to boluses of Ringer’s lactate was inadequate or ill-sustained. The dose of adrenaline was tailored to the patient’s response. In addition, the babies received supportive care and suitable antibiotics. Birth weight, gestational age, blood culture, mean arterial pressure (MAP), clinical features, dose of adrenaline required and outcome were recorded (Table I ).

Birth weight and gestational age ranged between 1400 to 3500 g and 31 to 39 weeks, respectively. Blood culture grew coagulase negative staphylococci in four, Klebsiella pneumoniae in two and b-hemolytic strepto-cocci, Staph. aureus and Pseudomonas in one each. Response to adrenaline was prompt in all of them, i.e., there was clinical improve-ment and return of MAP to previous reading. One of them developed tachycardia necessitat-ing discontinuation of adrenaline after 3 hours. The dose of adrenaline required ranged from 0.2 to 0.8 mg/kg/min. The age of administration ranged from 2 hours to 8 hours of life and duration of administration was for three to six days.

Shock is the commonest cause of death among newborn babies with sepsis. Impaired tissue perfusion leads to tissue hypoxemia and lactic acidosis which in turn affect functioning of different organs including heart. Depression of myocardial contractility has been shown in response to endotoxins in animal models and in patients using echocardiography, thermal dilution cardiac output and serial radionuclide cineangiography(1-3). Therefore, it is desirable to use and inotrope which raises blood pressure as well as cardiac output in cases of neonatal sepsis. Adrenaline may be preferred since it raises blood pressure by stimulating alpha receptors and improves cardiac output by stimulating b1 receptors(4). A randomized controlled trial has shown that both blood pressure and cardiac output improved with doses of 0.125 and 0.25 mg/kg/min(5).

Our objects had clinical features of sepsis supported by positive blood culture and clinical features of impaired perfusion supported by drop in MAP. Response to treatment was observed in all the cases. One child died 4 days after adrenaline administration. Adrenaline besides being an appropriate inotrope in cases of septic shock, is inexpensive and has wide dosage range. In our country, often adrenaline may have to be administered without an infusion pump. Even in such a situation, benefits of the therapy may outweigh the risks.

S.R. Daga,
D.V. Gosavi,
Bela Verma,
Cama and Albless Hospital,
Mumbai 400 001,
India.