Effect of Vasopressin on Systemic and Pulmonary Hemodynamics in Neonates

Abstract

Objective Despite its increasing use in neonates, the literature on the use of vasopressin (VP) in neonates is limited. The aim of this study is to evaluate the systemic and pulmonary effects of VP in neonates and to assess its safety among them.

Study Design This retrospective study enrolled all neonates in two level III neonatal intensive care units in Winnipeg, Manitoba, who had received VP therapy between 2011 and 2016. Infants with congenital malformations/chromosomal disorders were excluded. The changes in cardiovascular and pulmonary parameters were collected from patient charts. The primary outcome was the mean blood pressure (MBP) post-VP initiation. Secondary outcomes included systolic blood pressure (SBP) and diastolic blood pressure (DBP), vasoactive inotropic score (VIS), pH, urine output, lactate, base deficit (BD), mean airway pressure (MAP), and oxygen requirement.

Results A total of 33 episodes from 26 neonates were analyzed. The postnatal age at VP initiation was 14 days (interquartile range [IQR]: 4–25), and the median starting dose was 0.3 mU/kg/min (IQR: 0.2–0.5). MBP improved significantly after VP initiation from 28 to 39 mm Hg 24 hours after VP initiation (p < 0.001). Similar changes are observed with SBP and DBP. VIS declined from 15 to 6 at 24 hours, while pH, lactate, BD, and oxygen requirement improved significantly. While urine output marginally improved, there were no changes to MAP 24 hours post-VP initiation. Hyponatremia was observed in 21 episodes (64%) and severe hyponatremia in 7 episodes (33%).

Conclusion VP appears to be a promising rescue therapy in catecholamine resistant shock or refractory pulmonary hypertension in neonates.

Keywords

neonate - hypotension - vasopressin - septic shock - pulmonary hypertension

Authors' Contributors

T.B. performed the data collection, performed the initial data analysis, and created the first draft of the manuscript. Y.E. critically reviewed the manuscript. D.L. conceptualized the study, finalized the data analysis, reviewed the manuscript, and provided overall supervision for the study. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Publication History

Received: 23 March 2020

Accepted: 01 May 2020

Article published online:
02 June 2020

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