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Published on: December 31, 2015
Methylene Blue not Contraindicated in Treating Hemodynamic Instability in Pediatric and Neonate Patients
Walusa A Gonçalves-Ferri1, Agnes A S Albuquerque2, Patricia Martinez Evora2
1Department of Pediatrics, Ribeirão Preto Medical School-University of São Paulo, São Paulo, Brazil.
Insights
Methylene blue (MB) effectively treats vasodilatory shock in pediatric and neonatal patients, improving mean arterial pressure (MAP) and reducing the need for other medications. No severe side effects were reported, supporting its use in this age group.
Area of Science:
- Pharmacology
- Pediatric Critical Care
- Neonatology
Background:
- Vasoplegia and vasodilatory shock are critical conditions in pediatric and neonatal patients.
- Limited evidence exists on the efficacy and safety of methylene blue (MB) in pediatric populations.
Purpose of the Study:
- To review publications on methylene blue (MB) use in pediatrics and neonatology.
- To discuss MB's dose, infusion rate, action, and benefits for pediatric patients with vasoplegia.
Main Methods:
- Systematic review of PubMed, BioMed Central, and Embase databases.
- Inclusion of human studies evaluating MB in pediatric/neonatal patients (0-18 years) with vasoplegia.
- Exclusion of studies on non-vasoplegic patients or those aged 18+.
Main Results:
- Eleven studies were reviewed (10 case reports, 1 RCT), with only two focusing on neonates.
- All studies showed positive effects of MB on mean arterial pressure (MAP), enabling reduced vasoactive amine use.
- No severe side effects or deaths linked to MB were reported; maximum dose was 2 mg/kg.
Conclusions:
- Methylene blue (MB) demonstrates positive effects on MAP in pediatric patients with vasodilatory shock.
- Concerns regarding MB causing pulmonary hypertension or inflammatory distress syndrome in children lack theoretical or experimental support.
- Further research is needed to establish optimal dosing and administration protocols for MB in neonates and children.
Abstract:
The present review was carried out to describe publications on the use of methylene blue (MB) in pediatrics and neonatology, discussing dose, infusion rate, action characteristics, and possible benefits for a pediatric patient group. The research was performed on the data sources PubMed, BioMed Central, and Embase (updated on Aug 31, 2020) by two independent investigators. The selected articles included human studies that evaluated MB use in pediatric or neonatal patients with vasoplegia due to any cause, regardless of the applied methodology. The MB use and 0 to 18-years-old patients with vasodilatory shock were the adopted criteria. Exclusion criteria were the use of MB in patients without vasoplegia and patients ≥ 18-years-old. The primary endpoint was the increase in mean arterial pressure (MAP). Side effects and dose were also evaluated. Eleven studies were found, of which 10 were case reports, and 1 was a randomized clinical study. Only two of these studies were with neonatal patients (less than 28 days-old), reporting a small number of cases (1 and 6). All studies described the positive action of MB on MAP, allowing the decrease of vasoactive amines in several of them. No severe side effects or death related to the use of the medication were reported. The maximum dose used was 2 mg/kg, but there was no consensus on the infusion rate and drug administration timing. Finally, no theoretical or experimental basis sustains the decision to avoid MB in children claiming it can cause pulmonary hypertension. The same goes for the concern of a possible deleterious effect on inflammatory distress syndrome.
