Vasopressin for refractory persistent pulmonary hypertension of the newborn in preterm neonates - a case series.

Abstract

OBJECTIVE:

To describe the clinical outcomes following treatment with vasopressin for a sub-cohort of critically ill preterm neonates who have refractory persistent pulmonary hypertension of the newborn (PPHN).

DESIGN:

Case series.

SETTING:

Tertiary neonatal intensive care unit, Toronto, Canada.

POPULATION:

Neonates born <37 weeks gestational age (GA) who received vasopressin for refractory PPHN (lack of response to inhaled nitric oxide) over a 4-year period.

MEASUREMENTS:

Changes in physiological indices of cardio-pulmonary stability during vasopressin therapy were analyzed using one-way repeated measures ANOVA, compared to pretreatment values. Data regarding survival to discharge and neurodevelopmental outcomes at 18-24 months were described.

MAIN RESULTS:

Thirteen neonates with a mean GA of 31.4 ± 3.3 weeks were included. Vasopressin was initiated at 28.5 ± 4.5 h of age. Overall, oxygenation and hemodynamic variables improved significantly following vasopressin therapy (p < .05 at 24 h vs. pretreatment). Oxygenation failure resolved in 8 cases, of which 7 patients survived (6 without disability). Among the 5 cases where oxygenation failure persisted despite vasopressin, 4 died while one survived with disability.

CONCLUSIONS:

Vasopressin offers promise as a therapy for preterm neonates with refractory PPHN and hemodynamic instability, but prospective investigation is needed.

• Authors: Adel A Mohamed, Deepak Louis, Aimann Surak, Dany E Weisz, Patrick J McNamara, Amish Jain
• Journal: The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians (J Matern Fetal Neonatal Med) Vol. 35 Issue 8 Pg. 1475-1483 (Apr 2022) ISSN: 1476-4954 [Electronic] England
• PMID: 32349572 (Publication Type: Journal Article)

Chemical References

• Vasopressins
• Nitric Oxide

Topics

• Administration, Inhalation
• Humans
• Hypertension, Pulmonary (drug therapy)
• Infant, Newborn
• Nitric Oxide
• Persistent Fetal Circulation Syndrome (drug therapy)
• Prospective Studies
• Vasopressins (therapeutic use)