Document Detail


Low-dose vasopressin infusion therapy for refractory hypotension in ELBW infants.
MedLine Citation:
PMID:  19793209     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Severe hypotension in infants, especially in preterm infants, is associated with poor neurological outcome and high mortality. In adults, low-dose vasopressin (arginine vasopressin: AVP) infusion therapy has been effective for treating hypotension that is refractory to vasopressors and inotropes.
METHODS: The effects of AVP infusion therapy for refractory hypotension were retrospectively evaluated in extremely low-birthweight infants. Between January 2002 and November 2005, 22 infants with refractory hypotension treated with low-dose AVP infusion were reviewed. The average birthweight was 658 g (+/-142 g), and the average gestational age was 24.9 weeks (+/-1.4). The changes in blood pressure, urinary output, and other parameters in response to AVP therapy were analyzed in all the infants.
RESULTS: After AVP infusion, systolic blood pressure increased from 30 mmHg to 43 mmHg (P < 0.0001), and the diastolic pressure increased from 15 mmHg to 24 mmHg (P < 0.0001). The urine output dramatically increased from 1.5 mL/kg per h to 4.0 mL/kg per h (P < 0.0001). AVP infusion, however, was not effective in four of the 22 patients (18%). The sodium concentration in the serum decreased mildly after administration. In six patients the serum sodium concentration decreased below 130 mEq/L. Severe mitral regurgitation was observed in two patients. Three infants showed a transient decrease in the platelet count during AVP infusion.
CONCLUSIONS: Low-dose AVP therapy should be considered as rescue therapy when high-dose catecholamine therapy and/or steroid administration do not produce sufficient increase in the blood pressure. Further investigations are required to prove the efficacy and safety of AVP infusion therapy in preterm infants.
Authors:
Hitoshi Ikegami; Masahisa Funato; Hiroshi Tamai; Hiroshi Wada; Makoto Nabetani; Masato Nishihara
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Publication Detail:
Type:  Journal Article     Date:  2009-09-28
Journal Detail:
Title:  Pediatrics international : official journal of the Japan Pediatric Society     Volume:  52     ISSN:  1442-200X     ISO Abbreviation:  Pediatr Int     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-08-20     Completed Date:  2010-12-13     Revised Date:  2011-09-01    
Medline Journal Info:
Nlm Unique ID:  100886002     Medline TA:  Pediatr Int     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  368-73     Citation Subset:  IM    
Affiliation:
Department of Pediatrics, Yodogawa Christian Hospital, Osaka City, Osaka, Japan. a103146@ych.or.jp
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MeSH Terms
Descriptor/Qualifier:
Arginine Vasopressin / administration & dosage*
Blood Pressure Determination
Cohort Studies
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Resistance
Female
Follow-Up Studies
Humans
Hypotension / diagnosis,  drug therapy*,  mortality*
Infant, Extremely Low Birth Weight*
Infant, Newborn
Infant, Newborn, Diseases / drug therapy*,  mortality*
Infusions, Intravenous
Intensive Care Units, Neonatal
Male
Retrospective Studies
Risk Assessment
Severity of Illness Index
Survival Rate
Treatment Outcome
Chemical
Reg. No./Substance:
113-79-1/Arginine Vasopressin
Comments/Corrections
Comment In:
Pediatr Int. 2011 Apr;53(2):287   [PMID:  21501320 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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