Low-dose vasopressin infusion therapy for refractory hypotension in ELBW infants

Background:  Severe hypotension in infants, especially in preterm infants, is associated with poor neurological outcome and high mortality. In adults, low‐dose vasopressin (arginine vasopressin: AVP) infusion therapy has been effective for treating hypotension that is refractory to vasopressors and...

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Bibliographic Details
Published in:Pediatrics international 2010-06, Vol.52 (3), p.368-373
Main Authors: Ikegami, Hitoshi, Funato, Masahisa, Tamai, Hiroshi, Wada, Hiroshi, Nabetani, Makoto, Nishihara, Masato
Format: Article
Language:English
Subjects:
Arginine Vasopressin - administration & dosage
Blood pressure
Blood Pressure Determination
catecholamine
Cohort Studies
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Resistance
Drug therapy
extremely low-birthweight
Female
Follow-Up Studies
Humans
hypotension
Hypotension - diagnosis
Hypotension - drug therapy
Hypotension - mortality
Infant, Extremely Low Birth Weight
Infant, Newborn
Infant, Newborn, Diseases - drug therapy
Infant, Newborn, Diseases - mortality
Infusions, Intravenous
Intensive Care Units, Neonatal
Male
Neonatal care
Pediatrics
Premature birth
Retrospective Studies
Risk Assessment
Severity of Illness Index
Survival Rate
Treatment Outcome
vasopressin
very low-birthweight
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Summary:Background:  Severe hypotension in infants, especially in preterm infants, is associated with poor neurological outcome and high mortality. In adults, low‐dose vasopressin (arginine vasopressin: AVP) infusion therapy has been effective for treating hypotension that is refractory to vasopressors and inotropes. Methods:  The effects of AVP infusion therapy for refractory hypotension were retrospectively evaluated in extremely low‐birthweight infants. Between January 2002 and November 2005, 22 infants with refractory hypotension treated with low‐dose AVP infusion were reviewed. The average birthweight was 658 g (±142 g), and the average gestational age was 24.9 weeks (±1.4). The changes in blood pressure, urinary output, and other parameters in response to AVP therapy were analyzed in all the infants. Results:  After AVP infusion, systolic blood pressure increased from 30 mmHg to 43 mmHg (P < 0.0001), and the diastolic pressure increased from 15 mmHg to 24 mmHg (P < 0.0001). The urine output dramatically increased from 1.5 mL/kg per h to 4.0 mL/kg per h (P < 0.0001). AVP infusion, however, was not effective in four of the 22 patients (18%). The sodium concentration in the serum decreased mildly after administration. In six patients the serum sodium concentration decreased below 130 mEq/L. Severe mitral regurgitation was observed in two patients. Three infants showed a transient decrease in the platelet count during AVP infusion. Conclusions:  Low‐dose AVP therapy should be considered as rescue therapy when high‐dose catecholamine therapy and/or steroid administration do not produce sufficient increase in the blood pressure. Further investigations are required to prove the efficacy and safety of AVP infusion therapy in preterm infants.
ISSN:1328-8067
1442-200X
DOI:10.1111/j.1442-200X.2009.02967.x