Division of Neonatology, Department of Pediatrics and Child Health, Max Rady Faculty of Medicine, University of Manitoba, Winnipeg, Canada.
Am J Perinatol. 2021 Oct;38(12):1330-1334. doi: 10.1055/s-0040-1712999. Epub 2020 Jun 2.
Despite its increasing use in neonates, the literature on the use of vasopressin (VP) in neonates is limited. The aim of this study is to evaluate the systemic and pulmonary effects of VP in neonates and to assess its safety among them.
This retrospective study enrolled all neonates in two level III neonatal intensive care units in Winnipeg, Manitoba, who had received VP therapy between 2011 and 2016. Infants with congenital malformations/chromosomal disorders were excluded. The changes in cardiovascular and pulmonary parameters were collected from patient charts. The primary outcome was the mean blood pressure (MBP) post-VP initiation. Secondary outcomes included systolic blood pressure (SBP) and diastolic blood pressure (DBP), vasoactive inotropic score (VIS), pH, urine output, lactate, base deficit (BD), mean airway pressure (MAP), and oxygen requirement.
A total of 33 episodes from 26 neonates were analyzed. The postnatal age at VP initiation was 14 days (interquartile range [IQR]: 4-25), and the median starting dose was 0.3 mU/kg/min (IQR: 0.2-0.5). MBP improved significantly after VP initiation from 28 to 39 mm Hg 24 hours after VP initiation ( < 0.001). Similar changes are observed with SBP and DBP. VIS declined from 15 to 6 at 24 hours, while pH, lactate, BD, and oxygen requirement improved significantly. While urine output marginally improved, there were no changes to MAP 24 hours post-VP initiation. Hyponatremia was observed in 21 episodes (64%) and severe hyponatremia in 7 episodes (33%).
VP appears to be a promising rescue therapy in catecholamine resistant shock or refractory pulmonary hypertension in neonates.
尽管加压素（VP）在新生儿中的应用越来越多，但关于其在新生儿中的应用的文献却很有限。本研究旨在评估 VP 在新生儿中的全身和肺作用，并评估其在新生儿中的安全性。
这项回顾性研究纳入了 2011 年至 2016 年期间在马尼托巴省温尼伯市的两家三级新生儿重症监护病房接受 VP 治疗的所有新生儿。排除了患有先天性畸形/染色体疾病的婴儿。从患者图表中收集心血管和肺参数的变化。主要结局是 VP 起始后的平均血压（MBP）。次要结局包括收缩压（SBP）和舒张压（DBP）、血管活性正性肌力评分（VIS）、pH 值、尿量、乳酸、碱缺失（BD）、平均气道压（MAP）和氧需求。
共分析了 26 例新生儿的 33 个病例。VP 起始时的新生儿日龄为 14 天（四分位距 [IQR]：4-25），起始剂量中位数为 0.3 mU/kg/min（IQR：0.2-0.5）。VP 起始后 24 小时，MBP 从 28 至 39 mm Hg 显著改善（ < 0.001）。SBP 和 DBP 也观察到类似的变化。VIS 从 15 降至 24 小时的 6，而 pH 值、乳酸、BD 和氧需求显著改善。尽管尿量略有增加，但 VP 起始后 24 小时 MAP 无变化。21 例（64%）出现低钠血症，7 例（33%）出现严重低钠血症。
VP 似乎是治疗儿茶酚胺抵抗性休克或难治性肺动脉高压的一种有前途的抢救治疗方法。
