Use of Vasopressin as Rescue Therapy in Refractory Hypoxia and Refractory Systemic Hypotension in Term Neonates with Severe Persistent Pulmonary Hypertension—A Prospective Observational Study
-
Published:2022-10-27
Issue:
Volume:
Page:
-
ISSN:0735-1631
-
Container-title:American Journal of Perinatology
-
language:en
-
Short-container-title:Am J Perinatol
Author:
Shah Sachin1,
Dhalait Saleha1,
Fursule Anurag1,
Khandare Jayant1,
Kaul Amita1ORCID
Affiliation:
1. Department of Neonatal and Pediatric Intensive Care Services, Surya Mother & Child Superspeciality Hospital, Pune, Maharashtra, India
Abstract
Objective Persistent pulmonary hypertension of the newborn (PPHN) is a serious cardiorespiratory problem. PPHN is frequently associated with refractory hypoxia and hypotension, and optimal management has the potential to improve important clinical outcomes including mortality. The primary objective is to evaluate the efficacy and safety of rescue vasopressin (VP) therapy in the management of severe (refractory) hypoxia and refractory systemic hypotension in term neonates with severe PPHN.
Study Design Neonates with refractory hypoxia and refractory hypotension due to severe PPHN needing VP were prospectively enrolled in the study. Refractory hypoxia was defined as oxygenation index (OI) ≥ 25 for at least 4 hours after the commencement of high-frequency oscillatory ventilation and nitric oxide at 20 ppm. Refractory hypotension was defined as mean blood pressure lesser than mean gestational age lasting for more than 15 minutes in spite of dopamine infusion at 10 µg/kg/min, adrenaline infusion at 0.3 µg/kg/min, and noradrenaline infusion at 0.1 µg/kg/min.
Results Thirty-two neonates with PPHN were recruited. The baseline OI (mean ± standard deviation [SD]) before starting VP was 33.43 ± 16.54 which started decreasing significantly between 1 and 6 hours after the commencement of VP (p < 0.05). The mean blood pressure also increased concomitantly with a significant effect seen by 1 hour (p < 0.05). The vasoactive infusion score before the commencement of VP was mean 46.07 (SD = 25.72) and started decreasing after 12 to 24 hours of commencement of VP (p < 0.05). Lactate levels (mean ± SD) before starting VP were 7.8 ± 8.6 mmol/L and started decreasing between 6 and 12 hours (p < 0.05). Two neonates died due to refractory hypoxia and refractory hypotension (overall mortality 6.2%)
Conclusion Rescue VP therapy is a useful adjunct in the management of neonates with severe PPHN with refractory hypoxia and/or refractory hypotension. Improvement in oxygenation and hemodynamics with the use of VP results in reduced mortality.
Key Points
Publisher
Georg Thieme Verlag KG
Subject
Obstetrics and Gynecology,Pediatrics, Perinatology and Child Health
Reference16 articles.
1. Persistent pulmonary hypertension of the newborn;G Chetan;Biomedicine,2007
2. An Asian multicenter retrospective study on persistent pulmonary hypertension of the newborn: incidence, etiology, diagnosis, treatment and outcome;N Nakwan;J Matern Fetal Neonatal Med,2020
3. Utility of low dose vasopressin for persistent pulmonary hypertension of newborn with catecholamine refractory shock;C Khare;Indian J Pediatr,2021
4. Nitric oxide for respiratory failure in infants born at or near term;K J Barrington;Cochrane Database Syst Rev,2017
5. Variation in the management of persistent pulmonary hypertension of the newborn: a survey of physicians in Canada, Australia, and New Zealand;S Shivananda;Am J Perinatol,2012
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献