title: Renal vasodilatory action of arginine vasopressin in extremely low birth weight infants.
abstract: In extremely low birth weight (ELBW) infants, systemic hypotension is associated with poor neurological outcomes as a result of cerebral hypoperfusion. Treatment with arginine vasopressin (AVP) has been shown to increase blood pressure (BP) and urine output in ELBW infants suffering from refractory hypotension. The purpose of this study was to clarify whether low doses of AVP increased renal blood flow (RBF) in ELBW infants. We retrospectively analyzed data from the medical charts describing nine AVP infusions at 0.3-0.8 mU/kg/min in four ELBW infants. The median gestational age was 23 (22.5-23.5, interquartile range) weeks, and the median birth weight was 466 (414-563) g. Changes in the heart rate, BP, urine output, and RBF velocity patterns in response to the AVP infusions were compared using statistical analyses. The AVP infusion caused significant increases in systolic BP from 44 (41.0-47.0) to 50 (42.5-55.5) mmHg, diastolic BP from 17 (15.0-26.5) to 31 (28.5-33.0) mmHg, mean BP from 26 (24.5-30.5) to 36 (34.5-40.5) mmHg, and urine output from 1.4 (0.2-2.5) to 2.8 (1.0-8.6) mL/kg/hr. We also observed significant decreases in the resistance index from 1.0 (0.96-1.0) to 0.8 (0.71-0.91) and peak systolic flow velocity in the renal artery from 40 (27.2-50.6) to 28 (16.0-28.9) cm/s after AVP infusions. AVP infusions at 0.3-0.8 mU/kg/min in ELBW infants appeared to significantly increase the RBF by inducing renal vascular dilation and increasing the BP. Increasing the RBF most likely induces an increase in the glomerular filtration rate, resulting in the diuretic effect of AVP.
authors.affiliation: Division of Perinatal Medicine, Tohoku University Hospital.
authors.forename: Maiko
authors.initials: M
authors.lastname: Kaga
authors.forename: Tadashi
authors.initials: T
authors.lastname: Matsuda
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Watanabe
authors.forename: Sachiko
authors.initials: S
authors.lastname: Onodera
authors.forename: Shinpei
authors.initials: S
authors.lastname: Watanabe
authors.forename: Haruo
authors.initials: H
authors.lastname: Usuda
authors.forename: Satoko
authors.initials: S
authors.lastname: Ito
mesh_terms: D001127:Arginine Vasopressin / Q000008:administration & dosage / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D005260:Female; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight / Q000502:physiology* / Q000652:urine; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D012077:Renal Artery / Q000187:drug effects / Q000503:physiopathology; D013599:Systole / Q000187:drug effects; D014655:Vascular Resistance / Q000187:drug effects; D014664:Vasodilation / Q000187:drug effects*
chemical_list: D001127:Arginine Vasopressin