Low-dose vasopressin infusion therapy for refractory hypotension in ELBW infants.
BACKGROUND
Severe hypotension in infants, especially in preterm infants, is associated with poor neurological outcome and high mortality. In adults, low-dose vasopressin (arginine vasopressin: AVP) infusion therapy has been effective for treating hypotension that is refractory to vasopressors and inotropes.


METHODS
The effects of AVP infusion therapy for refractory hypotension were retrospectively evaluated in extremely low-birthweight infants. Between January 2002 and November 2005, 22 infants with refractory hypotension treated with low-dose AVP infusion were reviewed. The average birthweight was 658 g (+/-142 g), and the average gestational age was 24.9 weeks (+/-1.4). The changes in blood pressure, urinary output, and other parameters in response to AVP therapy were analyzed in all the infants.


RESULTS
After AVP infusion, systolic blood pressure increased from 30 mmHg to 43 mmHg (P < 0.0001), and the diastolic pressure increased from 15 mmHg to 24 mmHg (P < 0.0001). The urine output dramatically increased from 1.5 mL/kg per h to 4.0 mL/kg per h (P < 0.0001). AVP infusion, however, was not effective in four of the 22 patients (18%). The sodium concentration in the serum decreased mildly after administration. In six patients the serum sodium concentration decreased below 130 mEq/L. Severe mitral regurgitation was observed in two patients. Three infants showed a transient decrease in the platelet count during AVP infusion.


CONCLUSIONS
Low-dose AVP therapy should be considered as rescue therapy when high-dose catecholamine therapy and/or steroid administration do not produce sufficient increase in the blood pressure. Further investigations are required to prove the efficacy and safety of AVP infusion therapy in preterm infants.
Department of Pediatrics, Yodogawa Christian Hospital, Osaka City, Osaka, Japan. a103146@ych.or.jp
Hitoshi
H
Ikegami
Masahisa
M
Funato
Hiroshi
H
Tamai
Hiroshi
H
Wada
Makoto
M
Nabetani
Masato
M
Nishihara
D001127:Arginine Vasopressin / Q000008:administration & dosage*; D001795:Blood Pressure Determination; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007022:Hypotension / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000188:drug therapy* / Q000401:mortality*; D007262:Infusions, Intravenous; D007363:Intensive Care Units, Neonatal; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
D001127:Arginine Vasopressin