Effect of vasopressin infusion in refractory neonatal shock

BackgroundTo evaluate the effect of vasopressin infusion in refractory neonatal shock.MethodThis was a cohort study involving retrospective review of medical records of all neonates who received intravenous vasopressin infusion for at least 6 h for treatment of refractory shock in a level 3B neonatal intensive care unit of northern India between Jan 2016 to May 2021. Outcome measures assessed were systolic, diastolic, and mean blood pressure, heart rate, urine output, serum sodium level, inotrope score, and oxygenation index at 6, 12, 24, 48, and 72 h of vasopressin therapy. Outcome measures were compared before (T1) and 48 h (T2) after initiation of vasopressin.ResultsA total of 32 neonates received vasopressin. The mean (SD) systolic, diastolic, and mean blood pressure improved significantly between T1 and T2 from 54 (9) to 64 (11) mm Hg (MD (95% CI) = 10.3 (4.2-16.6), p = 0.003), 36 (8) to 42 (10) mm Hg (MD (95% CI) = 6.2 (1.3-11.3), p = 0.01), and 43 (8) to 51 (10) mm Hg (MD (95% CI) = 8.5 (2.3-14.6), p = 0.01), respectively. Median (IQR) urine output improved from 1.25 (0-3.2) to 2.1 (1.6-7) ml/kg/hr, p = 0.004. There was a significant fall in serum sodium from 139 (9) to 134 (8) mEq/l, p = 0.01. Out of 32 infants, 19 (59.4%) survived, while 6 (18.8 %) were transferred out and 7 (21.8%) died.ConclusionVasopressin improved hemodynamic parameters in refractory neonatal shock and can be used as a rescue therapy. Vasopressin therapy is associated with a fall in serum sodium.