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

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

• Rescue vasopressin is a useful adjunct in the management of neonates with severe PPHN.

• Vasopressin helps reduce OI.

• Vasopressin reduces the vasoactive inotrope score.

Keywords

vasopressin - persistent pulmonary hypertension of the newborn - refractory hypoxia - refractory hypotension

Authors' Contributions

S.S. conceptualized the study, analyzed the data, and wrote the manuscript.

S.D. was involved in data collection, reviewed the literature, and assisted in data analysis. A.F. helped in making the data sheet and helped in the analysis of the data. J.K. collected the data, reviewed the literature, and helped in data analysis, and A.K. assisted with the concept, made the study protocol, and reviewed and revised the manuscript.

All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

Ethical Approval

Approval was obtained from the institutional ethics review committee (Surya Mother & Child Superspeciality Hospital) before starting the study (approval no.: SRERC/2019/CT/01)

Publication History

Received: 31 July 2022

Accepted: 14 October 2022

Accepted Manuscript online:
27 October 2022

Article published online:
21 December 2022

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