Hemodynamic effects of noradrenaline in neonatal septic shock: a prospective cohort study

Abstract

Abstract BACKGROUND Neonatal sepsis is the third most common cause of neonatal mortality. The incidence of neonatal septic shock in low-income countries is 26.8% with a mortality rate of 35.4%. The hemodynamic effects of noradrenaline on the pediatric population have been well documented, but studies in neonates are sparse. This research was carried out to evaluate the effects of noradrenaline on the clinical and hemodynamic parameters in neonates with septic shock. METHODS This was a single-center prospective cohort study in a level III Neonatal intensive care unit of a tertiary care hospital. Neonates with sepsis defined by Tollners criteria and with evidence of shock and those who received noradrenaline as a first-line vasoactive agent for treatment were included. At baseline, demographic and clinical data and hemodynamic parameters were recorded and entered in a pre-designed case record form. The primary outcome measured was the response at the end of one hour of infusion of noradrenaline and the mortality rate. RESULTS A total of 21 babies received noradrenaline infusion for neonatal septic shock. The cohort comprised 17 preterm neonates (mean GA of 36.1 Weeks) with a median birth weight of 1.957. Resolution of shock at one hour of starting noradrenaline was achieved in 76.2% of cases. The median NICU stay was 5.5 days, and the median duration of hospital stay was 14 days. The mean blood pressure improved significantly after the initiation of noradrenaline infusion from a baseline of 30.6 mm of Hg (SD-6.1) to 37.8 mm of Hg (SD- 8.22, p < 0.001) at 1 hour after initiation of noradrenaline. Fractional shortening improved significantly after noradrenaline initiation from 29% (SD-13.5) at baseline to 45.1% (SD-21.1, p < 0.001) after 1 hour of noradrenaline. There was a mortality rate of 28.6% in our study. CONCLUSION Noradrenaline is a relatively safe and effective drug to use in the treatment of neonatal septic shock. Noradrenaline is effective in increasing blood pressure and improves left ventricular systolic function. Further studies with a larger sample size are needed to confirm our findings before it can be recommended as a first-line therapy in infants with neonatal shock.