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The effect of norepinephrine on clinical and hemodynamic parameters in neonates with shock: a retrospective cohort study

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Abstract

There is limited data on the cardiovascular effects of norepinephrine (NE) in neonates. Our objective was to describe the clinical responses in neonates treated with NE infusion. This retrospective cohort study included neonates with evidence of shock and those who received NE infusion. Primary outcome: changes in mean blood pressure (MBP) at 6, 12, and 24 h post-initiation of NE. Secondary outcomes: Changes in (i) diastolic BP, systolic BP, and vasoactive inotrope score (VIS) at 6, 12, and 24 h, (ii) urine output after initiation of NE ii) pH, lactate, fraction of inspired oxygen (FiO2) after initiation of NE, and (iv) adverse outcomes. Fifty infants received NE with mean (SD) gestational age of 34.3 (4.3) weeks and a mean birth weight of 2215 (911) g. Treatment began at a median age of 36 (IQR: 15.2, 67.2) hours of life and lasted 30.5 (IQR: 12.7, 58) hours. MBP improved from 34.4 mm Hg (SD: 6.6) at baseline to 39.4 mm Hg (SD: 10.5, p < 0.001) at 6 h, to 39.6 mm Hg (SD: 12.1, p = 0.002) at 12 h and to 40.4 mm Hg (SD: 15.5, p = 0.004) at 24 h after NE initiation. Vasoactive inotrope score declined from 30 (20, 32) to 10 (4, 30; p < 0.001) at 24 h. Urine output improved within 24 h [1.5 ml/kg/h (0.5, 2.3) at baseline to 3 (1.9, 4.3) at 24 h; p = 0.04]. Oxygen requirement decreased after NE initiation.

Conclusion: The use of NE appears to be effective and safe for treating systemic hypotension in neonates. Trial registration: Being a retrospective study, trial registration was not considered.

What is known:

• Dopamine has traditionally been used as the initial agent for treatment of neonatal hypotension.

• Norepinephrine has recently been recommended as the first-choice vasopressor agent to correct hypotension in adults and pediatric patients, with insufficient data on the cardiovascular effects of NE in neonates

What is new:

• Mean blood pressure improved significantly at 6, 12, and 24 h with reduction in vasoactive infusion score at 12 and 24 h after norepinephrine infusion.

• No significant change in heart rate or abnormal abdominal adverse effects noted in this study.

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Data availability

Our manuscript has no associated data or the data will not be deposited.

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Not applicable.

Abbreviations

BP:

Blood pressure

BPD:

Broncho-pulmonary dysplasia

BW:

Birth weight

DBP:

Diastolic blood pressure

FiO2:

Fraction of inspired oxygen

IVH:

Intraventricular hemorrhage

MBP:

Mean blood pressure

NE:

Norepinephrine

NEC:

Necrotizing enterocolitis

NICU:

Neonatal intensive care unit

PVL:

Periventricular leukomalacia

ROP:

Retinopathy of prematurity

SBP:

Systolic blood pressure

SD:

Standard deviation

VIS:

Vasoactive inotrope score

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Authors and Affiliations

  1. Department of Paediatrics and Neonatology, Cloudnine Hospital, Gurugram, Haryana, 122003, India

    Shelly Gupta, Gopal Agrawal, Sarvesh Thakur, Ankit Gupta & Sanjay Wazir

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  1. Shelly Gupta
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  2. Gopal Agrawal
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  3. Sarvesh Thakur
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  4. Ankit Gupta
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Contributions

Shelly Gupta, Ankit Gupta, Sarvesh Thakur, and Gopal Agrawal: helped in study design, collected and analyzed the data, and drafted the manuscript. Gopal Agrawal and Sanjay Wazir: planned the study, supervised the collection and analysis of data, and did critical revision and finalization of the manuscript.

Corresponding author

Correspondence to Gopal Agrawal.

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Being a retrospective study, no ethical approval was sought.

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The authors declare no competing interests.

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Communicated by Daniele De Luca

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Gupta, S., Agrawal, G., Thakur, S. et al. The effect of norepinephrine on clinical and hemodynamic parameters in neonates with shock: a retrospective cohort study. Eur J Pediatr 181, 2379–2387 (2022). https://doi.org/10.1007/s00431-022-04437-4

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  • DOI: https://doi.org/10.1007/s00431-022-04437-4

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