Vasopressin as a rescue therapy for refractory pulmonary hypertension in neonates: case series

To determine the effect of vasopressin therapy on the efficacy of oxygenation and arterial pressure in infants with severe persistent pulmonary hypertension of the newborn.

Retrospective case study.

Neonatal ICU, Hospital for Sick Children, Toronto, Canada.

Neonates with severe persistent pulmonary hypertension.

Intravenous infusion of vasopressin.

Ten infants satisfied the inclusion criteria. Inhaled nitric oxide was used for median (interquartile range) duration of 15 hours (11-28 hr) prior to vasopressin commencement. Vasopressin was initiated at a mean dose of 0.0002 ± 0.0002 U/kg/min for a median (interquartile range) duration of 49 hours (13-95 hr). Administration of vasopressin was associated with an improvement in oxygenation index, peak effect 6 hours after drug initiation (p = 0.01), and a reduction in inhaled nitric oxide dose (p < 0.05). There was a concomitant improvement in blood pressure (p < 0.05) and urine output (p < 0.05), without drop in the serum sodium level or worsening in serum lactate level.

Although there is limited experience of vasopressin use in persistent pulmonary hypertension of the newborn infants, our case series suggests it to be a potential adjunctive therapy for improving the efficacy of oxygenation and systemic hypotension. A prospective randomized trial is needed to confirm its efficacy and safety in the management of severe persistent pulmonary hypertension of the newborn.