pituitrin and Infant--Premature--Diseases

Topics: Adult; Animals; Congenital Hypothyroidism; Diseases in Twins; Female; Humans; Hyponatremia; Hypothyroidism; Infant; Infant, Newborn; Infant, Premature, Diseases; Male; Pregnancy; Thyroxine; Vasopressins

Topics: Acids; Acute Kidney Injury; Angiotensin II; Bicarbonates; Diuretics; Glomerular Filtration Rate; Hematuria; Homeostasis; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Infant, Premature, Diseases; Kidney; Kidney Function Tests; Kidney Tubules; Phosphates; Potassium; Renal Veins; Renin; Sodium; Uric Acid; Vasopressins

Topics: Birth Weight; Body Fluids; Edema; Estrogens; Humans; Hypoproteinemia; Infant, Newborn; Infant, Premature, Diseases; Sclerema Neonatorum; Syndrome; Vasopressins; Water-Electrolyte Balance

To evaluate vasopressin vs dopamine as initial therapy in extremely low birth weight (ELBW) infants with hypotension during the first 24 hours of life.. ELBW infants with hypertension ≤ 30 weeks' gestation and ≤ 24 hours old randomly received treatment with vasopressin or dopamine in a blinded fashion. Normotensive infants not receiving vasopressor support served as a comparison group.. Twenty ELBW infants with hypertension received vasopressin (n = 10) or dopamine (n = 10), and 50 were enrolled for comparison. Mean gestational age was 25.6 ± 1.4 weeks and birth weight 705 ± 154 g. Response to vasopressin paralleled that of dopamine in time to adequate mean blood pressure (Kaplan-Meier curve, P = .986); 90% of infants in each treatment group responded with adequate blood pressure. The vasopressin group received fewer doses of surfactant (P < .05), had lower PaCO2 values (P < .05), and were not tachycardic (P < .001) during vasopressin administration, compared with the dopamine group.. Vasopressin in ELBW infants as the initial agent for early hypotension appeared safe. This pilot study supports a larger randomized controlled trial of vasopressin vs dopamine therapy in ELBW infants with hypotension.

Topics: Blood Pressure; Cardiotonic Agents; Dopamine; Dose-Response Relationship, Drug; Double-Blind Method; Feasibility Studies; Female; Follow-Up Studies; Gestational Age; Humans; Hypotension; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infusions, Intravenous; Male; Pilot Projects; Prospective Studies; Treatment Outcome; Vasoconstrictor Agents; Vasopressins

Topics: Blood Pressure; Dopamine; Female; Humans; Hypotension; Infant, Extremely Low Birth Weight; Infant, Premature; Infant, Premature, Diseases; Male; Vasopressins

Topics: Blood Pressure; Dopamine; Female; Humans; Hypotension; Infant, Extremely Low Birth Weight; Infant, Premature; Infant, Premature, Diseases; Male; Vasopressins

To determine trends in pharmacotherapy for neonatal hypotension in all infants and in extremely low birth weight (ELBW, birth weight 300-1000 g) infants.. We queried the Pediatric Health Information System database for all infants ≤28 days with a diagnosis code for hypotension that were discharged between January 2001 and December 2012. Patients were excluded if they had complex congenital heart disease or cardiac surgery, sepsis or meningitis, or had extracorporeal membrane oxygenation. We determined trends in pharmacotherapy for hypotension in all infants and ELBW infants, an especially vulnerable group.. A total of 8019 hypotensive infants met study criteria. The 2 most prescribed medications were dopamine (65.3%) and dobutamine (19.9%). For 1487 hypotensive ELBW infants, the 2 most prescribed medications were dopamine (83.4%) and hydrocortisone (33%). During the study period, the use of dobutamine decreased, and hydrocortisone and vasopressin use increased for all infants and for ELBW infants.. Treatment of neonatal hypotension varies widely between institutions and individual practitioners, and pharmacotherapy for neonatal hypotension has changed over the past decade. Although dopamine and dobutamine were the most frequently used agents, their use has declined and the uses of hydrocortisone and vasopressin have increased.

Topics: Blood Pressure; Dobutamine; Dopamine; Drug Therapy; Extracorporeal Membrane Oxygenation; Female; Humans; Hydrocortisone; Hypotension; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Meningitis; Pediatrics; Retrospective Studies; Tertiary Care Centers; Time Factors; Treatment Outcome; Vasopressins

To evaluate vasopressin as a rescue therapy in catecholamine-refractory septic and cardiogenic shock in very-low-birthweight (VLBW) infants.. Prospective assessment of vasopressin therapy in three VLBW infants with catecholamine-refractory septic shock (24 + 6 wk, 600 g) and cardiogenic shock (26 + 1 wk, 890 g; 26 + 1 wk, 880 g) at a university hospital.. Adequate systemic arterial blood pressure could only be restored after vasopressin administration as a continuous infusion over a 36-h period in the preterm suffering from septic shock; in the two neonates with cardiogenic shock, only a transient stabilization in mean arterial pressure was observed, which did not impact on the poor prognosis.. Although vasopressin appears to be a suitable rescue therapy in catecholamine-resistant septic shock in VLBW infants, further evaluation in controlled clinical trials is warranted.

Topics: Diseases in Twins; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Norepinephrine; Shock, Cardiogenic; Shock, Septic; Treatment Failure; Vasoconstrictor Agents; Vasopressins

Topics: Blood Pressure; Cerebral Hemorrhage; Cerebral Ventricles; Humans; Inappropriate ADH Syndrome; Infant, Newborn; Infant, Premature, Diseases; Vasopressins

When comparing iatrogenic inhibition with endogenous stimulation of renal prostaglandin production, the role of this mediator and modulator system for renal function becomes apparent. Renal perfusion and glomerular filtration as well as modulation of tubular function with respect to electrolyte and water excretion is significantly influenced by renal prostaglandin activity. Treatment with the prostaglandin cyclooxygenase inhibitor indomethacin reduces the endogenous creatinine clearance by about fifty percent in a state of a diminished circulatory blood volume, such as may exist during left-to-right shunting across a persistent ductus arteriosus in preterm infants. In addition, urinary electrolyte and water excretion is reduced by increased tubular absorption leading to marked oliguria. In contrast, electrolytes and water are lost in congenital renal tubular disorders associated with increased prostaglandin E2 (PGE2) activity (a so called hyperprostaglandin E syndrome). Patients with this renal disorder require a permanent high dosed indomethacin therapy. After this pharmacotherapy has brought electrolyte and water metabolism into balance, no deterioration of glomerular filtration and renal perfusion was observed. This is in accordance with the general principle that renal function only becomes dependent on the vasodilatory activity of renal prostaglandins in a stress situation resulting in the threat of hypoperfusion. It is essential to bear in mind the physiological and pathophysiological role of renal prostaglandins, when prescribing frequently administered prostaglandin cyclooxygenase inhibitors like aspirin, paracetamol or indomethacin in pediatrics. Otherwise, renal function may deteriorate or the kidney will be irreversibly damaged.

Topics: Angiotensin II; Aspirin; Child, Preschool; Creatinine; Ductus Arteriosus, Patent; Glomerular Filtration Rate; Humans; Indomethacin; Infant; Infant, Newborn; Infant, Premature, Diseases; Kidney Diseases; Kidney Function Tests; Oliguria; Prostaglandins; Prostaglandins E; Renal Circulation; Renin-Angiotensin System; Vasopressins; Water-Electrolyte Balance

Adverse renal reaction during prolonged indomethacin therapy (1 week) was studied in 15 preterm infants with persistent ductus arteriosus (PDA), which was associated with an ineffective circulatory volume. Following the medication a decrease in diuresis and creatinine clearances together with an increase in urinary osmolality and body weight was observed. Determinations of selected vasoactive hormones, such as plasma renin activity (PRA), antidiuretic hormone (ADH), and renal and systemic prostaglandins, indicated a complex pathophysiological condition of renal hypoperfusion and antidiuretic excess. During the treatment with indomethacin an effective circulatory volume had been restored by closing the ductus, which was followed by hormonal normalization. Subsequently kidney function was recovering despite continued indomethacin therapy. Based on these observations, one may assume that prolonged indomethacin therapy for prevention of PDA relapses is probably of no further harm to kidney function once the ductus has been closed successfully.

Topics: Blood Volume; Body Weight; Ductus Arteriosus, Patent; Humans; Indomethacin; Infant, Newborn; Infant, Premature, Diseases; Kidney; Kidney Function Tests; Oliguria; Osmolar Concentration; Prostaglandins; Renin; Time Factors; Vasopressins

Topics: Arginine Vasopressin; Ductus Arteriosus, Patent; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Syndrome; Vasopressins

Topics: Dehydration; Diagnosis, Differential; Humans; Hyponatremia; Infant, Newborn; Infant, Premature, Diseases; Syndrome; Vasopressins

Topics: Cerebral Hemorrhage; Diabetes Insipidus; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Parenteral Nutrition; Vasopressins

A 6-week-old infant born prematurely had severe hyponatremia and other features of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). This disturbance was believed to be secondary to extensive bilateral pneumonia with collapse of the right upper lobe. Although this association has been recognized in adults, this is the first report of its occurrence in an infant. SIADH must be considered in the differential diagnosis of hyponatremia in association with pneumonia in an infant.

Topics: Humans; Hyponatremia; Infant; Infant, Newborn; Infant, Premature, Diseases; Male; Pneumonia, Viral; Radiography; Secretory Rate; Vasopressins