Patel Kavita, Thomson Sharon, Vijayan Meera, Makoni Marjorie, Johnson Peter N, Stephens Katy, Neely Stephen B, Miller Jamie L
Department of Pharmacy, University Health, San Antonio, TX, United States.
Department of Pharmacy, Oklahoma Children's Hospital at OU Health, Oklahoma City, OK, United States.
Front Pediatr. 2024 Oct 2;12:1465785. doi: 10.3389/fped.2024.1465785. eCollection 2024.
Vasopressin is used for shock and acute pulmonary hypertension in the neonatal intensive care unit (NICU) and is associated with hyponatremia. The purpose of this study was to determine the incidence, severity, contributing risk factors associated with vasopressin-induced hyponatremia in neonates and infants <3 months of age in the NICU. The primary objective was to determine the incidence of hyponatremia (<130 mEq/L) and severe hyponatremia (<125 mEq/L). The secondary objectives were to compare clinical characteristics and the vasopressin regimen between those with and without hyponatremia.
This retrospective cohort study included neonates and infants <3 months from 1/1/2017-12/31/2022 receiving vasopressin for >6 h. Analyses were performed using SAS v9.4, with less than 0.05. A multiple variable logistic regression was employed to assess odds of hyponatremia.
Of the 105 patients included, 57 (54.3%) developed hyponatremia, and 17 (29.8%) were classified as severe hyponatremia. Overall, the median (interquartile range, IQR) gestational and postnatal age at vasopressin initiation were 35.4 (27-38.7) weeks and 2 (1-12) days. There was no difference in vasopressin dose, but duration of treatment was longer in those with hyponatremia. Higher baseline serum sodium was associated with decreased odds of hyponatremia [adjusted odds ratio (OR): 0.90 (95% CI: 0.83-0.99), = 0.03], and increased vasopressin duration was associated with increased odds of hyponatremia [aOR: 1.02 (95% CI: 1.01-1.03), < 0.001].
Hyponatremia occurred in half of patients included. The pre-vasopressin sodium value and the vasopressin duration were independently associated with hyponatremia.
血管加压素用于新生儿重症监护病房（NICU）的休克和急性肺动脉高压治疗，且与低钠血症相关。本研究的目的是确定NICU中3个月龄以下新生儿和婴儿因血管加压素诱发低钠血症的发生率、严重程度及相关危险因素。主要目的是确定低钠血症（<130 mEq/L）和严重低钠血症（<125 mEq/L）的发生率。次要目的是比较发生低钠血症和未发生低钠血症患者的临床特征及血管加压素治疗方案。
这项回顾性队列研究纳入了2017年1月1日至2022年12月31日期间接受血管加压素治疗超过6小时的3个月龄以下新生儿和婴儿。使用SAS v9.4进行分析，P值小于0.05。采用多变量逻辑回归评估低钠血症的发生几率。
纳入的105例患者中，57例（54.3%）发生低钠血症，17例（29.8%）为严重低钠血症。总体而言，开始使用血管加压素时的孕周和出生后年龄中位数（四分位间距，IQR）分别为35.4（27 - 38.7）周和2（1 - 12）天。血管加压素剂量无差异，但发生低钠血症患者的治疗持续时间更长。较高的基线血清钠水平与低钠血症发生几率降低相关[调整后的优势比（OR）：0.90（95%置信区间：0.83 - 0.99），P = 0.03]，血管加压素使用持续时间增加与低钠血症发生几率增加相关[aOR：1.02（95%置信区间：1.01 - 1.03），P < 0.001]。
纳入患者中有一半发生了低钠血症。血管加压素使用前的钠值和血管加压素使用持续时间与低钠血症独立相关。
