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Terlipressin as rescue therapy for intractable hypotension during neonatal septic shock
Ilan Matok1, Leah Leibovitch, Amir Vardi
1Department of Pharmacy Services, Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Terlipressin successfully treated intractable hypotension in an 8-day-old infant with septic shock. This case suggests terlipressin as a potential rescue therapy for pediatric septic shock when catecholamines fail.
Area of Science:
- Pediatric Critical Care Medicine
- Neonatal Septic Shock Management
- Pharmacological Interventions in Pediatrics
Background:
- Septic shock in neonates presents a significant challenge, often requiring aggressive management.
- Intractable hypotension despite maximal catecholamine support is a critical complication in pediatric septic shock.
- Limited therapeutic options exist for refractory hypotension in infants with septic shock.
Observation:
- A case report details an 8-day-old infant experiencing intractable hypotension secondary to septic shock post-cardiac surgery.
- The infant received comprehensive intensive care, including mechanical ventilation, volume resuscitation, and high-dose inotropic agents (dopamine, milrinone, epinephrine).
- Despite maximal conventional therapy, profound hypotension persisted, necessitating rescue treatment.
Findings:
- Terlipressin was administered at 7 mcg/kg twice daily as rescue therapy for the refractory hypotension.
- Following terlipressin initiation, significant improvements in blood pressure and systemic perfusion were observed.
- This suggests a direct therapeutic effect of terlipressin in reversing the hypotension.
Implications:
- Terlipressin shows promise as a rescue therapy for pediatric septic shock with intractable hypotension unresponsive to catecholamines.
- Further research is warranted to establish the efficacy and safety profile of terlipressin in infant and pediatric populations.
- This case highlights the potential role of terlipressin in managing severe pediatric hemodynamic compromise.
Objective:
To report the successful use of terlipressin in an 8-day-old infant for treatment of intractable hypotension caused by septic shock.
Design:
Descriptive case report.
Setting:
An 18-bed pediatric intensive care unit at a tertiary care children's hospital.
Patient:
An 8-day-old child with intractable hypotension due to septic shock after heart surgery.
Interventions:
General supportive intensive care including mechanical ventilatory support, volume replacement, and inotropic support with dopamine 20 microg.kg(-1).min(-1), milrinone 0.75 microg.kg(-1).min(-1), and epinephrine 0.8 microg.kg(-1).min(-1).
Measurements And Main Results:
Terlipressin (7 microg/kg per dose twice daily) was added as rescue therapy because of profound intractable hypotension. Shortly after the beginning of treatment, blood pressure and perfusion dramatically improved.
Conclusions:
There is circumstantial evidence that the administration of terlipressin caused the increase in blood pressure. We suggest that terlipressin should be considered as rescue therapy when high-dose catecholamine therapy does not result in sufficient perfusion pressure. Further investigation is needed to prove terlipressin's effectiveness and safety in infants and children.
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