Vasopressin as adjunctive therapy in pulmonary hypertension associated with refractory systemic hypotension in term newborns
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Date
2022
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Abstract Objective. The aim of our study is to describe the effects of vasopressin on term infants with persistent pulmonary hypertension under a standardized protocol. Study Design: In 2019, we designed a standardized protocol for the management of refractory hypotension in the context of pulmonary hypertension, which included the use of vasopressin. This is a retrospective cohort study to evaluate the clinical, laboratory, and echocardiographic outcomes of patients who required vasopressin in the context of this new protocol in a referral level IV neonatal intensive care unit. Results: We included 48 neonates with a median gestational age of 37 weeks in a period of 30 months (December 2019 to May 2022). Congenital diaphragmatic hernia was the main cause of persistent pulmonary hypertension in this cohort (82%). All patients were on mechanical ventilation and receiving inhaled nitric oxide. In our cohort at 4 hours after initiation of vasopressin, blood pressure, serum pH, and urinary output increased significantly. The vasoactive inotropic score, lactate and oxygenation index decreased. Echocardiographic follow-up also showed a decrease in the relative pressure of the right ventricle and an improvement in the cardiac output of both ventricles. There were no episodes of severe hyponatremia (<120 mmol/L). Discussion: This study showed that the use of vasopressin in neonates with persistent pulmonary hypertension and refractory systemic hypotension was associated with a rapid and significant improvement in oxygenation and hemodynamic markers of perfusion, including blood pressure. This association was early during the first hours of treatment and vasopressin was safely withdrawn after a median of 3 days of treatment.