Mohamed Adel A, Louis Deepak, Surak Aimann, Weisz Dany E, McNamara Patrick J, Jain Amish
Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada.
Department of Pediatrics, Sunnybrook Hospital, Toronto, Canada.
J Matern Fetal Neonatal Med. 2022 Apr;35(8):1475-1483. doi: 10.1080/14767058.2020.1757642. Epub 2020 Apr 29.
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).
Case series.
Tertiary neonatal intensive care unit, Toronto, Canada.
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.
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.
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 ( < .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.
Vasopressin offers promise as a therapy for preterm neonates with refractory PPHN and hemodynamic instability, but prospective investigation is needed.
描述血管加压素治疗一组患有难治性新生儿持续性肺动脉高压（PPHN）的危重新生儿的临床结局。
病例系列。
加拿大多伦多的三级新生儿重症监护病房。
在4年期间，孕周小于37周（GA）且因难治性PPHN（对吸入一氧化氮无反应）接受血管加压素治疗的新生儿。
使用单向重复测量方差分析，将血管加压素治疗期间心肺稳定性的生理指标变化与治疗前值进行比较。描述了出院生存率和18至24个月时的神经发育结局数据。
纳入13例平均GA为31.4±3.3周的新生儿。血管加压素在出生后28.5±4.5小时开始使用。总体而言，血管加压素治疗后氧合和血流动力学变量显著改善（24小时时与治疗前相比，P<0.05）。8例氧合衰竭得到缓解，其中7例存活（6例无残疾）。在5例尽管使用血管加压素但氧合衰竭仍持续的病例中，4例死亡，1例存活但有残疾。
血管加压素有望成为治疗难治性PPHN和血流动力学不稳定的早产儿的一种疗法，但需要进行前瞻性研究。
