pituitrin and Persistent-Fetal-Circulation-Syndrome

There is a distinct lack of age-appropriate cardiotonic drugs, and adult derived formulations continue to be administered, without evidence-based knowledge on their dosing, safety, efficacy, and long-term effects. Dopamine remains the most commonly studied and prescribed cardiotonic drug in the neonatal intensive care unit (NICU), but evidence of its effect on endorgan perfusion still remains. Unlike adult and pediatric critical care, there are significant gaps in our knowledge on the use of various cardiotonic drugs in various forms of circulatory failure in the NICU.

Topics: Adrenal Cortex Hormones; Asphyxia Neonatorum; Cardiotonic Agents; Dobutamine; Dopamine; Heart Defects, Congenital; Humans; Hypotension; Infant, Newborn; Intensive Care Units, Neonatal; Milrinone; Neonatal Sepsis; Norepinephrine; Persistent Fetal Circulation Syndrome; Shock; Simendan; Vasoconstrictor Agents; Vasopressins

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).. Case series.. Tertiary neonatal intensive care unit, Toronto, Canada.. 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.. 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.. 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 (. Vasopressin offers promise as a therapy for preterm neonates with refractory PPHN and hemodynamic instability, but prospective investigation is needed.

Topics: Administration, Inhalation; Humans; Hypertension, Pulmonary; Infant, Newborn; Nitric Oxide; Persistent Fetal Circulation Syndrome; Prospective Studies; Vasopressins

To evaluate the effect of low dose vasopressin on the hemodynamics of neonates with persistent pulmonary hypertension and catecholamine refractory shock.. 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.. 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.. In resource-restricted settings, LDV may be useful as a rescue therapy for persistent pulmonary hypertension of newborn with catecholamine refractory shock.

Topics: Catecholamines; Humans; India; Infant, Newborn; Persistent Fetal Circulation Syndrome; Retrospective Studies; Vasoconstrictor Agents; Vasopressins

Topics: Catecholamines; Humans; Infant, Newborn; Persistent Fetal Circulation Syndrome; Vasopressins