Vasopressin for Refractory Hypotension in Extremely Low Birth Weight Infants

Bidegain, Margarita; Greenberg, Rachel G.; Simmons, Catherine A.; Dang, C N; Cotten, C. Michael; Smith, Patrick B.

doi:10.1016/j.jpeds.2010.04.038

Cited by 60 publications

(28 citation statements)

References 12 publications

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“…In all reports, conventional therapy with volume resuscitation and vasopressors/inotropes were given prior to the initiation of AVP/TP (excluding one study which included volume resuscitation or dopamine) [27]. Three RCTs [27–29] and five clinical trials [30–34] met the 1b and 1c level criteria of the CEBM [19], and two RCTs had a low risk for bias (Additional file 2: Figure S1) [27, 29]. The studies included evaluated the effect of AVP/TP in the pediatric population over a relatively wide range of ages, and the majority of the studies were not restricted to shock arising from a specific mechanism.…”

Section: Resultsmentioning

confidence: 99%

Role of vasopressin and terlipressin in refractory shock compared to conventional therapy in the neonatal and pediatric population: a systematic review, meta-analysis, and trial sequential analysis

et al. 2017

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BackgroundVasopressin (AVP) and terlipressin (TP) have been used as last-line therapy in refractory shock in children. However, the efficacy and safety profiles of AVP and TP have not been determined in pediatric refractory shock of different origins. We aimed to assess the efficacy and safety of the addition of AVP/TP therapy in pediatric refractory shock of all causes compared to conventional therapy with fluid resuscitation and vasopressor and inotropic therapy.MethodsWe conducted a systematic review, meta-analysis, and trial sequential analysis (TSA) comparing AVP and TP to conventional therapy. MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov were searched up to February 2016. The systematic review included all reports of AVP/TP use in the pediatric population. Reports of clinical trials were pooled using random-effects models and TSA. Main outcomes were mortality and tissue ischemia.ResultsThree randomized controlled trials and five “before-and-after clinical” trials (without comparator) met the inclusion criteria. Among 224 neonates and children (aged 0 to 18 years) with refractory shock, 152 received therapy with AVP or TP. Pooled analyses showed no association between AVP/TP treatment and mortality (relative risk (RR),1.19; 95% confidence interval (CI), 0.71–2.00), length of stay in the pediatric intensive care unit (PICU) (mean difference (MD), –3.58 days; 95% CI, –9.05 to 1.83), and tissue ischemia (RR, 1.48; 95% CI, 0.47–4.62). In TSA, no significant effect on mortality and risk for developing tissue ischemia was observed with AVP/TP therapy.ConclusionOur results emphasize the lack of observed benefit for AVP/TP in terms of mortality and length of stay in the PICU, and suggest an increased risk for ischemic events. Our TSA suggests that further large studies are necessary to demonstrate and establish benefits of AVP/TP in children.PROSPERO registry: CRD42016035872Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1589-6) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Role of vasopressin and terlipressin in refractory shock compared to conventional therapy in the neonatal and pediatric population: a systematic review, meta-analysis, and trial sequential analysis

et al. 2017

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“…In a retrospective analysis of 33 separate VP infusions in 20 ELBW infants with refractory shock unresponsive to catecholamines/corticosteroids VP has resulted in increased blood pressure and decrease in inotrope requirement [100]. In a case series of 4 preterm patients low dose vasopressin (0.3-0.8mU/kg/min) has been effective in increasing blood pressure, renal blood flow and urine output.…”

Section: Evidence and Pd Effectsmentioning

confidence: 99%

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

Ergenekon

Rojas-Anaya

Bravo

et al. 2018

CPD

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Background: Circulatory failure in preterm and term newborn infants is commonly treated with inotropes or vasoactive medications. In this structured literature review the available data on pharmacodynamic effects of the inotropes adrenaline, dobutamine, dopamine, levosimendan, milrinone, noradrenaline, and the vasoactive drugs vasopressin and hydrocortisone are presented. Methods: Structured searches were conducted to identify relevant articles according to pre-defined inclusion criteria which were human clinical trials published after 2000.Results: Out of 101 identified eligible studies only 22 studies met the criteria for evidence based practice guidelines level I to IV. The most prevalent pharmacodynamic effects were increase in blood pressure and/or heart rate, which were also the most frequently studied circulatory parameters. Conclusion: This review demonstrates the need for further systematic studies on all reviewed drugs with incorporation of novel noninvasive biomarkers in this vulnerable patient group, for more timely and appropriate treatment for clinical efficacy.

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“…The causes of hypotension in ELBW infants are diverse, including septic shock, gastrointestinal perforation, intraventricular hemorrhage, and adrenal insufficiency. Recent studies have reported that arginine vasopressin (AVP) infusion is an effective treatment for ELBW patients exhibiting hypotension refractory to treatment with catecholamines and adrenocorticosteroids (Meyer et al 2006;Bidegain et al 2010;Ikegami et al 2010). Treatment with AVP was originally shown to increase blood pressure (BP) in hypotensive adult patients with septic shock (Landry et al 1997).…”

Section: Introductionmentioning

confidence: 99%

Renal Vasodilatory Action of Arginine Vasopressin in Extremely Low Birth Weight Infants

Kaga

Matsuda

Watanabe

et al. 2013

Tohoku J. Exp. Med.

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In extremely low birth weight (ELBW) infants, systemic hypotension is associated with poor neurological outcomes as a result of cerebral hypoperfusion. Treatment with arginine vasopressin (AVP) has been shown to increase blood pressure (BP) and urine output in ELBW infants suffering from refractory hypotension. The purpose of this study was to clarify whether low doses of AVP increased renal blood flow (RBF) in ELBW infants. We retrospectively analyzed data from the medical charts describing nine AVP infusions at 0.3-0.8 mU/kg/min in four ELBW infants. The median gestational age was 23 (22.5-23.5, interquartile range) weeks, and the median birth weight was 466 (414-563) g. Changes in the heart rate, BP, urine output, and RBF velocity patterns in response to the AVP infusions were compared using statistical analyses. The AVP infusion caused significant increases in systolic BP from 44 (41.0-47.0) to 50 (42.5-55.5) mmHg, diastolic BP from 17 (15.0-26.5) to 31 (28.5-33.0) mmHg, mean BP from 26 (24.5-30.5) to 36 (34.5-40.5) mmHg, and urine output from 1.4 (0.2-2.5) to 2.8 (1.0-8.6) mL/kg/hr. We also observed significant decreases in the resistance index from 1.0 (0.96-1.0) to 0.8 (0.71-0.91) and peak systolic flow velocity in the renal artery from 40 (27.2-50.6) to 28 (16.0-28.9) cm/s after AVP infusions. AVP infusions at 0.3-0.8 mU/kg/min in ELBW infants appeared to significantly increase the RBF by inducing renal vascular dilation and increasing the BP. Increasing the RBF most likely induces an increase in the glomerular filtration rate, resulting in the diuretic effect of AVP.Keywords: arginine vasopressin; diuretic effect; extremely low birth weight infants; renal blood flow; renal vasodilation Tohoku J. Exp. Med., 2013 November, 231 (3), 159-164.

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Vasopressin for Refractory Hypotension in Extremely Low Birth Weight Infants

Cited by 60 publications

References 12 publications

Role of vasopressin and terlipressin in refractory shock compared to conventional therapy in the neonatal and pediatric population: a systematic review, meta-analysis, and trial sequential analysis

Role of vasopressin and terlipressin in refractory shock compared to conventional therapy in the neonatal and pediatric population: a systematic review, meta-analysis, and trial sequential analysis

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

Renal Vasodilatory Action of Arginine Vasopressin in Extremely Low Birth Weight Infants

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