Utility of Low Dose Vasopressin for Persistent Pulmonary Hypertension of Newborn with Catecholamine Refractory Shock
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ORIGINAL ARTICLE
Utility of Low Dose Vasopressin for Persistent Pulmonary Hypertension of Newborn with Catecholamine Refractory Shock Chetan Khare 1 & Bethou Adhisivam 2 & B. Vishnu Bhat 2,3 & Dheeraj Vaishnav 4 Received: 7 February 2020 / Accepted: 25 September 2020 # Dr. K C Chaudhuri Foundation 2020
Abstract Objective To evaluate the effect of low dose vasopressin on the hemodynamics of neonates with persistent pulmonary hypertension and catecholamine refractory shock. Methods This retrospective study was conducted in a level III NICU of a tertiary care teaching hospital, south India. Eighteen neonates with hypoxemic respiratory failure due to persistent pulmonary hypertension of newborn with catecholamine refractory shock were studied. Neonates were managed for hypotension with conventional inotropic support with the additional use of low dose vasopressin (LDV). Effect of vasopressin on oxygenation index (OI), blood pressure, duration of inotropic usage and survival was evaluated. Results Mean OI was 38.2 ± 4.9, and mean blood pressure was 30.7 ± 5.3 mmHg before the start of vasopressin. Initiation of LDV (0.0003 ± 0.0001 IU/kg/min) for a median duration 36.4 ± 17.9 h was followed by a reduction in OI (p < 0.001), control of hypotension (p < 0.001), reduction in lactic acidosis (p < 0.001) and decline in inotropic support. Conclusions In resource-restricted settings, LDV may be useful as a rescue therapy for persistent pulmonary hypertension of newborn with catecholamine refractory shock. Keywords Catecholamine refractory shock . Low dose vasopressin . Persistent pulmonary hypertension . Neonatal hypotension
Introduction Circulatory collapse/hypotension often complicates the course of persistent pulmonary hypertension of newborn (PPHN). Non-responders to Inhaled nitric oxide (iNO) or refractory shock, have been successfully managed with low dose vasopressin (LDV) [1–7]. Continuous infusion of LDV raises systemic vascular resistance (V1a mediated action) while Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12098-020-03519-1) contains supplementary material, which is available to authorized users. * Bethou Adhisivam [email protected] 1
Department of Neonatology, AIIMS, Rishikesh, India
2
Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India
3
Department of Pediatrics, AVMC, Puducherry, India
4
Department of Neonatology, Geetanjali Institute of Medical Sciences, Udaipur, Rajasthan, India
vasodilation occurs in pulmonary, coronary, and renal tissues (V2 mediated action) [8–11]. Low vasopressin levels in septic preterm neonates were associated with progression to shock, hence it is possible to explore the clinical utility of its replacement in hypotensive neonates [12]. Vasopressin is advocated in rescue situations for neonatal shock [13, 14]. Pharmacological LDV ranges from 0.00001 IU/kg/min to 0.003 IU/kg/min [15]. The rationale to study vasopressin was based on its success
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