Limited Evidence of Noradrenaline Use and Effectiveness in Preterm Neonates: A Systematic Review

Aim: The study aimed to analyse the effects and associated outcomes of noradrenaline in treating hypotension in preterm neonates. Methods: We searched PubMed, Web of Science, and Scopus to August 2025 for randomised and observational studies on noradrenaline use in preterm neonates. The studies were summarised without statistical pooling. Results: Of 202 screened abstracts, eight studies (one randomised controlled trial [RCT], seven observational) were included. In total, 340 preterm infants were treated with noradrenaline. Sample sizes ranged from 21 to 70. The risk of bias was low in the RCT and moderate to critical in the observational studies. Mortality was similar in the RCT and lower in one observational study comparing noradrenaline to dopamine, although evidence certainty was very low. Evidence for bronchopulmonary dysplasia, intraventricular haemorrhage, and necrotising enterocolitis was limited and showed no consistent differences between treatments. Noradrenaline consistently increased mean blood pressure within hours, but the effect on heart rate was modest. Conclusion: Noradrenaline increases blood pressure and improves perfusion markers in preterm infants with hypotensive shock. However, evidence comparing it with dopamine is limited and of very low certainty. Noradrenaline may be effective, but robust comparative studies are needed to confirm its safety and efficacy, especially in extremely preterm infants.