Neonatal outcome following norepinephrine versus phenylephrine for treatment of spinal-induced hypotension among women undergoing caesarean section: systematic review and meta-analysis of randomised controlled trials
Authors' conclusion
This systematic review and meta-analysis shows women treated with bolus or infusion, prophylactic or therapeutic administration of norepinephrine have comparable neonatal outcome and maternal haemodynamics with phenylephrine.
Study context
- Population
- Normal pregnancies undergoing caesarean section under spinal anaesthesia
- Participants
- 2,603 pregnancies · 19 RCTs
- Comparison
- Norepinephrine vs phenylephrine for spinal-induced hypotension
- Outcome
- Neonatal outcomes and maternal haemodynamic effects
Pooled result
As reported in the abstract
- No statistically significant difference vs phenylephrine, prophylactic or therapeutic
Further pooled results
| Outcome | MD (95% CI) | P value | |
|---|---|---|---|
| Umbilical arterial partial carbon dioxideNorepinephrine vs Phenylephrine · bolus | −0.98 (−3.32-1.35) | P = 0.41 | |
| Umbilical arterial partial carbon dioxideNorepinephrine vs Phenylephrine · combined bolus and infusion | 0.25 (−0.42-1.92) | ||
| −4−202Difference (linear scale) |
5 min Apgar score (therapeutic vs prophylactic norepinephrine)
- Slightly higher 5 min Apgar with therapeutic administration
Umbilical arterial partial carbon dioxide
- No statistically significant difference
Umbilical arterial bicarbonate (therapeutic norepinephrine vs prophylactic or combined phenylephrine)
- Significantly increased bicarbonate with therapeutic norepinephrine
Safety
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Maternal bradycardiaTherapeutic | 0.46 (0.29–0.72) | P = 0.0006 | |
| 0.20.5125Relative risk (log scale) |
| Outcome | Estimate | P value |
|---|---|---|
| Maternal reflex hypertension (combined prophylactic and therapeutic)Printed as "RR = 0.29,95%CI:0.12-0.65" | (95% CI 0.12–0.65) | P = 0.003 |
Maternal bradycardia
- Norepinephrine significantly reduced risk of maternal bradycardia
Maternal reflex hypertension (combined prophylactic and therapeutic)
- Lower risk of maternal reflex hypertension with combined administration
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
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