Vasopressin for refractory persistent pulmonary hypertension of the newborn in preterm neonates – a case series. (18th April 2022)

• Record Type: Journal Article
• Authors: Mohamed, Adel A.; Louis, Deepak; Surak, Aimann; Weisz, Dany E.; McNamara, Patrick J.; Jain, Amish
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 35:Number 8(2022)
• Page Start: 1475
• Page End: 1483
• Publication Date: 2022-04-18
• Subjects: Hypoxia -- neonates -- premature -- vasopressin -- hypoxic respiratory failure -- pulmonary hypertension; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2020.1757642
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Objective: To describe the clinical outcomes following treatment with vasopressin for a sub-cohort of critically ill preterm neonates who have refractory persistent pulmonary hypertension of the newborn (PPHN). Design: Case series Setting: Tertiary neonatal intensive care unit, Toronto, Canada. Population: Neonates born <37 weeks gestational age (GA) who received vasopressin for refractory PPHN (lack of response to inhaled nitric oxide) over a 4-year period. Measurements: Changes in physiological indices of cardio-pulmonary stability during vasopressin therapy were analyzed using one-way repeated measures ANOVA, compared to pretreatment values. Data regarding survival to discharge and neurodevelopmental outcomes at 18–24 months were described. Main Results: Thirteen neonates with a mean GA of 31.4 ± 3.3 weeks were included. Vasopressin was initiated at 28.5 ± 4.5 h of age. Overall, oxygenation and hemodynamic variables improved significantly following vasopressin therapy ( p < .05 at 24 h vs. pretreatment). Oxygenation failure resolved in 8 cases, of which 7 patients survived (6 without disability). Among the 5 cases where oxygenation failure persisted despite vasopressin, 4 died while one survived with disability. Conclusions: Vasopressin offers promise as a therapy for preterm neonates with refractory PPHN and hemodynamic instability, but prospective investigation is needed.