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Utility of Low Dose Vasopressin for Persistent Pulmonary Hypertension of Newborn with Catecholamine Refractory Shock

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Abstract

Objective

To evaluate the effect of low dose vasopressin on the hemodynamics of neonates with persistent pulmonary hypertension and catecholamine refractory shock.

Methods

This retrospective study was conducted in a level III NICU of a tertiary care teaching hospital, south India. Eighteen neonates with hypoxemic respiratory failure due to persistent pulmonary hypertension of newborn with catecholamine refractory shock were studied. Neonates were managed for hypotension with conventional inotropic support with the additional use of low dose vasopressin (LDV). Effect of vasopressin on oxygenation index (OI), blood pressure, duration of inotropic usage and survival was evaluated.

Results

Mean OI was 38.2 ± 4.9, and mean blood pressure was 30.7 ± 5.3 mmHg before the start of vasopressin. Initiation of LDV (0.0003 ± 0.0001 IU/kg/min) for a median duration 36.4 ± 17.9 h was followed by a reduction in OI (p < 0.001), control of hypotension (p < 0.001), reduction in lactic acidosis (p < 0.001) and decline in inotropic support.

Conclusions

In resource-restricted settings, LDV may be useful as a rescue therapy for persistent pulmonary hypertension of newborn with catecholamine refractory shock.

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Authors and Affiliations

  1. Department of Neonatology, AIIMS, Rishikesh, India

    Chetan Khare

  2. Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, 605006, India

    Bethou Adhisivam & B. Vishnu Bhat

  3. Department of Pediatrics, AVMC, Puducherry, India

    B. Vishnu Bhat

  4. Department of Neonatology, Geetanjali Institute of Medical Sciences, Udaipur, Rajasthan, India

    Dheeraj Vaishnav

Authors
  1. Chetan Khare
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  2. Bethou Adhisivam
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  3. B. Vishnu Bhat
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  4. Dheeraj Vaishnav
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Contributions

CK: Collected and analysed the data; BA: Supervised the study and edited the manuscript; BVB: Supervised the study; DV: Helped in data collection. BA will act as guarantor for this paper.

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Correspondence to Bethou Adhisivam.

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Supplementary Fig. 1

Study flowchart. CCHD Critical congenital heart disease; CDH Congenital diaphragmatic hernia; HIE Hypoxic ischemic encephalopathy; HRF Hypoxic respiratory failure; LAMA Left against medical advice; MAS Meconium aspiration syndrome; NEC Necrotising enterocolitis; OI Oxygenation index; PPHN Persistent pulmonary hypertension of newborn; TH Therapeutic hypothermia. *Neonates with poor prognostic factors (PNG 56 kb)

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Khare, C., Adhisivam, B., Bhat, B.V. et al. Utility of Low Dose Vasopressin for Persistent Pulmonary Hypertension of Newborn with Catecholamine Refractory Shock. Indian J Pediatr 88, 450–454 (2021). https://doi.org/10.1007/s12098-020-03519-1

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  • DOI: https://doi.org/10.1007/s12098-020-03519-1

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