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Methylene Blue for Refractory Shock in A Neonate
Ferhan Demirtaş1, Yasemin Ezgi Köstekci1, Aziz Kılıç2
1Division of Neonatology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey.
Zeitschrift Fur Geburtshilfe Und Neonatologie
|June 16, 2025
Summary
Methylene blue (MB) shows potential in treating neonatal shock resistant to standard therapies. This case study explores its use in a newborn with hyperammonemia, highlighting its impact on blood pressure and renal replacement therapy.
Area of Science:
- Neonatology
- Pediatric Critical Care
- Pharmacology
Background:
- Neonatal shock carries a high mortality rate, necessitating novel therapeutic strategies.
- Catecholamine-resistant shock is a critical concern in neonates, often linked to metabolic disorders.
- Methylene blue (MB), a potential vasopressor, is infrequently used in the neonatal population.
Purpose of the Study:
- To report the use of Methylene blue (MB) in a neonate with catecholamine-resistant shock and hyperammonemia.
- To evaluate the efficacy of MB in conjunction with renal replacement therapy (RRT) for severe hyperammonemia.
- To assess MB as a potential therapeutic alternative in refractory neonatal shock.
Main Methods:
- Case report of a neonate with hyperammonemia and shock.
- Initiation of protein restriction, ammonia-lowering medications, and RRT.
- Administration of Methylene blue (MB) for persistent hypotension unresponsive to conventional treatments.
- Continuous RRT was performed post-MB administration.
Main Results:
- The neonate presented with severe hyperammonemia, encephalopathy, and refractory shock.
- Methylene blue (MB) administration led to improved blood pressure, facilitating effective RRT.
- Ammonia levels decreased following continuous RRT.
- Despite treatment, the patient succumbed to multiple organ failure on the tenth postnatal day.
Conclusions:
- Methylene blue (MB) may serve as a viable therapeutic option for neonates experiencing decompensated catecholamine-resistant shock with normal cardiac function.
- Further research is warranted to establish the efficacy, optimal dosage, and safety profile of MB in neonates.
- Early identification and management of hyperammonemia are crucial in neonatal critical care.
