Rescue treatment with terlipressin in different scenarios of refractory hypotension in newborns and infants.
OBJECTIVE
Terlipressin has been successfully used as rescue treatment in hypotensive adults and children with septic shock, but only exceptionally in neonates. The aim of this study is to describe original clinical scenarios in which terlipressin, in newborns and infants, resolved the catecholamine-refractory hypotension.


METHODS
Retrospective study.


METHODS
Neonatal intensive care unit.


METHODS
All newborns with hypotension unresponsive to volume replacement and catecholamines, and treated with terlipressin, from January 2008 to December 2009. In this study, also an infant (11 months old) born extremely preterm was included.


METHODS
None.


RESULTS
Four hypotensive patients received as rescue therapy terlipressin, which produced a dramatic increase in mean arterial pressure, diuresis, and reduction of lactate levels. In three newborns, hypotension, associated with pulmonary hypertension, was resolved with terlipressin. Two of them (one with systemic inflammatory response syndrome, the other with congenital diaphragmatic hernia) died in the following days for causes unrelated to hypotension; the third (on mild hypothermia for hypoxic-ischemic encephalopathy) recovered. We report furthermore an infant with septic shock and on treatment with β-blockers in whom terlipressin normalized blood pressure. In two patients, cranial Doppler ultrasonography showed the recovery of diastolic cerebral flow in the anterior cerebral artery and the normalization of resistance index within 30 mins from the first dose of terlipressin. In two infants, hyponatremia was detected.


CONCLUSIONS
Although the number of reported infants is little, terlipressin appears to be an effective rescue treatment in different scenarios of refractory neonatal hypotension. Further controlled studies are required to confirm its efficacy and safety.
Department of Critical Care Medicine, A. Meyer University Children's Hospital, Florence, Italy. l.fillippi@meyer.it
Luca
L
Filippi
Elena
E
Gozzini
Marta
M
Daniotti
Francesca
F
Pagliai
Serena
S
Catarzi
Patrizio
P
Fiorini
D002395:Catecholamines / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007022:Hypotension / Q000000981:diagnostic imaging / Q000188:drug therapy*; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007558:Italy; D008236:Lypressin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008297:Male; D008485:Medical Audit; D012189:Retrospective Studies; D012772:Shock, Septic; D000077585:Terlipressin; D014463:Ultrasonography; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D002395:Catecholamines; D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin