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
