Methylene blue for the management of pediatric patients with vasoplegic syndrome

Methylene Blue Use in Pediatrics

“…Hassan et al have reported similar results with a mean increase of 16 mm Hg in MAP at 1-hour post-administration in children with vasoplegia following bypass. 7 While 5 out of 16 had a decrease in MAP after 1 hour and 6 out of 16 at 6 hours, two had improved VIS at 6 hours.…”

“…We describe a cohort which includes 16 pediatric patients, including four neonates, in the United States with refractory shock who received MB without any major side effects or complications. MB has been used in children with vasoplegia following cardiopulmonary bypass, [7][8][9] and Mehaffey et al have reported the use of MB in adult patients with vasoplegia after cardiopulmonary bypass with decreased operative mortality with early use. 10 In our cohort, 12 patients had a prior history of congenital cardiac disease (75%), 11 received MB following cardiotomy (69%), and 4 received it within 24 hours postoperatively (22%).…”

“…The five pediatric studies that have described MB dosing report ranges from 1 to 2 mg/kg/ dose. 7,8,11,13,14 In the adult population, the literature has shown a range of 0.5 to 4 mg/kg/dose with continuous dosing of 0.25 to 2 mg/kg/h. [15][16][17] Our cohort of patients received bolus dosing with a range of 1 to 2 mg/kg/dose and median of 1 mg/kg/dose.…”

Methylene Blue to Neonatal Septic Shock treatment in neonate pigs,

“…Only 10 case reports and one non-randomized clinical trial were found. 6 , 9 , 10 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 Of these, only two reported cases of newborn infants. 9 , 10…”

“…The roles of the l-arginine and NO pathways in pediatric and neonatal patients are well documented. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 Nevertheless, research on MB treatment in these patient age groups is scarce. There is no substantial evidence that contraindicates the use of MB.…”