Division of Neonatology, Department of Pediatrics, Sultan Qaboos University, Muscat 123, Oman.
Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON L8S 4L8, Canada.
Int J Environ Res Public Health. 2022 Oct 22;19(21):13760. doi: 10.3390/ijerph192113760.
The use of arginine vasopressin (AVP) and terlipressin to treat hypotension in preterm neonates is increasing. Our aim was to review the available evidence on the efficacy and safety of AVP and terlipressin for use in preterm neonates.
MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar from inception to September 2021 were searched for studies of AVP and terlipressin in the treatment of hypotension of any cause in preterm neonates. Primary outcomes were improvement in end-organ perfusion and mortality. The risk of bias assessment and certainty of the evidence were performed using appropriate tools.
Fifteen studies describing the use of AVP (n = 12) or terlipressin (n = 3) among 148 preterm neonates were included. Certainly, the available evidence for the primary outcome of end-organ perfusion rated as very low. AVP or terlipressin were used to treat 144 and 4 neonates, respectively. Improvement in markers of end-organ perfusion was reported in 143 (99%) neonates treated with AVP and 3 (75%) treated with terlipressin. The mortality rate was 41% (n = 59) and 50% (n = 2) for neonates who received AVP and terlipressin, respectively. Hyponatremia was the most frequently reported adverse event (n = 37, 25%).
AVP and terlipressin may improve measured blood pressure values and possibly end-organ perfusion among neonates with refractory hypotension. However, the efficacy-safety balance of these drugs should be assessed on an individual basis and as per the underlying cause. Studies on the optimal dosing, efficacy, and safety of AVP and terlipressin in preterm neonates with variable underlying conditions are critically needed.
使用精氨酸加压素（AVP）和特利加压素治疗早产儿低血压的情况越来越多。我们旨在回顾 AVP 和特利加压素治疗早产儿低血压的疗效和安全性的现有证据。
从建库到 2021 年 9 月，我们检索了 MEDLINE、EMBASE、Cochrane 中央对照试验注册库、Web of Science 和 Google Scholar，以查找 AVP 和特利加压素治疗任何原因引起的早产儿低血压的研究。主要结局为终末器官灌注的改善和死亡率。使用适当的工具进行偏倚风险评估和证据确定性。
共纳入了 15 项研究，描述了 148 例早产儿中使用 AVP（n = 12）或特利加压素（n = 3）的情况。终末器官灌注的主要结局的证据肯定是极低的。AVP 或特利加压素分别用于治疗 144 例和 4 例早产儿。143 例（99%）接受 AVP 治疗的早产儿和 3 例（75%）接受特利加压素治疗的早产儿报告了终末器官灌注标志物的改善。接受 AVP 和特利加压素治疗的早产儿的死亡率分别为 41%（n = 59）和 50%（n = 2）。最常报道的不良事件是低钠血症（n = 37，25%）。
AVP 和特利加压素可能改善难治性低血压新生儿的血压测量值，并可能改善终末器官灌注。然而，这些药物的疗效-安全性平衡应根据个体情况和潜在病因进行评估。急需研究不同潜在疾病的早产儿中 AVP 和特利加压素的最佳剂量、疗效和安全性。
