Safety of octreotide in hospitalized infants

Testoni, Daniela; Hornik, Christoph P.; Neely, Megan L.; Yang, Qinghong; McMahon, Ann; Clark, Reese H.; Smith, Paul

doi:10.1016/j.earlhumdev.2015.04.008

Cited by 28 publications

(32 citation statements)

References 34 publications

(36 reference statements)

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“…Although rare, elevated blood urea nitrogen, increased serum markers of cholestasis, and hypoor hyperglycemia have been also described. 7 Luckily, none of the AE potentially related to octreotide administration occurred in the infant described in the present case report.…”

Section: Discussionmentioning

confidence: 93%

“…Although there is agreement that continuous infusion is the preferred method for octreotide administration, a wide range of the daily dose has been reported. 7,12,18 The dosage used in the current study was relatively low, and was chosen taking into account the infant's critical condition, low weight, and gestational age, all of which could affect drug metabolism.…”

Section: Discussionmentioning

confidence: 99%

“…Testoni et al 7 recently described the clinical characteristics of newborns who received octreotide: up to twothirds of them were preterm and had a median weight >2 kg on the first day of treatment. To the best of our knowledge, the administration of octreotide in ELBW infants is limited to a few reports about newborns with chylothorax, 14 -16 who were treated with shorter courses.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 The use of octreotide in newborns has also increased over the past decade. The most common indication is chylothorax 7 as, by decreasing intestinal fat absorption, octreotide contributes to the reduction of lymphatic flow in the thoracic duct. As for GI diseases, there is little evidence about the use of octreotide for GI hemorrhage, bloody stools, and closure of postsurgical EF, 7,8 but no reports for NEC.…”

Section: Discussionmentioning

confidence: 99%

“…Although its off-label use in critically ill infants is increasing, 7 the effect of octreotide on perforated NEC has not been described yet. Moreover, there are very few data about its use in infants <1 kg body weight.…”

mentioning

confidence: 99%

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Octreotide in a Critically Ill Extremely Preterm Infant With Perforated Necrotizing Enterocolitis

et al. 2016

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Necrotizing enterocolitis (NEC) is the most severe gastrointestinal complication of prematurity. Surgery, either peritoneal drainage placement or laparotomy with resection of the intestinal necrotic tracts, is the definitive treatment of perforated NEC; however, when clinical conditions contraindicate surgical approaches, little is known about medical treatments adjuvant or alternative to surgery. Octreotide is a synthetic somatostatin analog that inhibits pancreatic secretion and leads to splanchnic vasoconstriction. In preterm neonates, it is mainly used off-label for chylothorax and congenital hyperinsulinism, whereas gastrointestinal indications are limited. We describe the case of a critically ill extremely low birth weight infant with perforated NEC, who had unsuccessfully undergone peritoneal drainage placement and laparotomy. Her unstable condition contraindicated a further laparotomy, thus off-label treatment with octreotide was attempted. No adverse events occurred. The infant’s condition gradually improved and progressive reduction of peritoneal outputs and successful resolution of pneumoperitoneum were achieved, with no relapse after octreotide discontinuation.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Octreotide in a Critically Ill Extremely Preterm Infant With Perforated Necrotizing Enterocolitis

et al. 2016

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Octreotide use and safety in infants with hyperinsulinism

McMahon

Wharton

Thornton

et al. 2016

Pharmacoepidemiology and Drug

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Background Octreotide is a synthetic peptide analog of naturally occurring somatostatin. Octreotide is used off-label in children <6 years of age for hyperinsulinism, chylothorax, and gastrointestinal bleeding. There is a lack of controlled data on efficacy or potential adverse events from this off-label use. Methods Three pediatric hospitals participated in this study. Patients were hospitalized January 2007–December 2010 and administered octreotide for congenital hyperinsulinism (CHI) at least 1 day. Variables assessed included octreotide dosage, patient demographics, medical interventions, concomitant medicines, serious adverse events (SAEs) including necrotizing enterocolitis (NEC), and mortality. Results The 103 patient sample had a median gestational age of 38 weeks. During the study period, two patients died: one from NEC and the other from cardiomyopathy/sepsis. There were 11 other SAEs in the 101 surviving patients. Conclusion This study highlights potential risks in administering octreotide off-label. This study, like several other published studies, has highlighted NEC in a full-term infant treated with octreotide. It is important to study the efficacy and the safety of octreotide for hyperinsulinism. In the interim, it might be prudent to prescribe octreotide in CHI neonates only in the absence of other risk factors for NEC.

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Management and outcomes of congenital chylothorax in the neonatal intensive care unit: A case series

Healy

Gipson

Hay

et al. 2017

Pediatric Investigation

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Importance Congenital chylothorax is a rare condition with pulmonary and multiorgan system effects, for which there are no standardized treatment recommendations. Collective review of known cases offers some conclusions and suggestions for treatment. Objective The aim of this study was to present a case series of 5 patients who were treated in the neonatal intensive care unit with chylothorax. Methods We describe 5 infants who were diagnosed prenatally with hydrops fetalis and postnatally had clinically significant congenital chylothorax. Results Treatment guidelines specific to congenital forms of chylothorax have not yet been developed, although there are consistent trends across our cases. Four of the 5 infants in this study have survived to date. Chylothorax was treated with chest tube placement and chylous fluid drainage, scrupulous attention to fluid balance, mechanical ventilation, and nutritional management and, in 3 cases, with octreotide infusions. Some of the infants also required treatment for immunodeficiency and altered coagulation pathways. None of the infants underwent surgical thoracic duct ligation. Interpretation Aided by the advantage of prenatal diagnosis, many cases of congenital chylothorax can be successfully treated by a combination of nutritional and medical management as well as careful attention to fluid and electrolyte balance and avoidance of infection, thereby avoiding the need for surgical ligation of the thoracic duct.

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Safety of octreotide in hospitalized infants

Cited by 28 publications

References 34 publications

Octreotide in a Critically Ill Extremely Preterm Infant With Perforated Necrotizing Enterocolitis

Octreotide in a Critically Ill Extremely Preterm Infant With Perforated Necrotizing Enterocolitis

Octreotide use and safety in infants with hyperinsulinism

Management and outcomes of congenital chylothorax in the neonatal intensive care unit: A case series

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