Maximum Norepinephrine Dosage as an Priming Indicator for Vasopressin Therapy for Neonatal Septic Shock: A Retrospective Study

Abstract

Vasopressin is uesd as a second-line vasopressor for neonates with septic shock, but the optimal timing of initiation is uncertain. We hypothesized that norepinephrine (NE) dosage is associated with neonatal septic shock mortality, and can be used for determining the optimal timing of vasopressin therapy in neonates. This study explores the correlation between the maximum norepinephrinedosage (MND) and mortality in neonates with septic shock, aiming to inform the timing of vasopressin therapy in such cases. This retrospective cohort study included neonates with evidence of septic shock and those who received NE infusion. The predictive efficacy of MND for mortality was analyzed using receiver operating characteristic (ROC) curves, and its correlation was assessed via multivariate logistic regression. Pearson correlation analysis was employed to examine the relationship between MND and poor prognostic indicators. The study included 123 neonates, with 106 in the survival group and 17 in the death group. The death group had significantly lower birth weight (p=0.022), 1-min Apgar score (p=0.005), serum albumin (p＜0.001), pH value (p=0.013), and base excess (BE) (p=0.001) levels, but higher lactate (LAC) levels (p=0.009). MND demonstrated an ROC area under the curve of 0.775 (95% CI: 0.63-0.92, p＜0.001) for predicting mortality, with an optimal threshold of 0.3 µg/(kg·min), a sensitivity of 82.4%, and a specificity of 75.5%. Multivariatelogistic regression indicated that an MND > 0.3 µg/(kg·min) (OR, 64.45, 95% CI: 3.04-1364.94) significantly increased mortality risk. Spearman rank correlation showed a positive correlation between MND and LAC (r=0.252, p=0.005), vasoactive-inotropic score (VIS) (r=0.836, p＜0.001), and a negative correlation with BE (r=-0.311, p=0.001). Conclusions: MND > 0.3 µg/(kg·min) is closely associated with mortality in neonates with septic shock and can serve as a primary auxiliary tool for deciding the timing of vasopressin therapy.