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.
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).