Vasopressin for refractory persistent pulmonary hypertension of the newborn in preterm neonates – a case series

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.

Keywords:

• Hypoxia
• neonates
• premature
• vasopressin
• hypoxic respiratory failure
• pulmonary hypertension

Ethical approval

The study was approved by the institutional research ethics board.

Authors contributions

Adel A. Mohamed initiated the concept, participated in the design, collected data, analyzed data, and wrote the first draft of the manuscript.

Deepak Louis participated in design, data collection, interpretation of results and manuscript preparation.

Aimann Surak participated in design, data collection, interpretation of results and manuscript preparation.

Dany Weisz participated in the design, manuscript revision and compiled the final draft

Patrick J. McNamara participated in the design, manuscript revision and compiled the final draft

Amish Jain participated in the design, analyzed data and revised and compiled the final draft

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This project is conducted as a part of “Improving Management of Pulmonary hypertension and Right heart function in Neonates (IMPRINT)” research program. The funding for this program is provided to AJ by the Heart & Stroke Foundation of Canada (HSFC).