Vasopressin for refractory persistent pulmonary hypertension of the newborn in preterm neonates – a case series
Adel Mohamed, Deepak Louis, Aimann Surak, Dany E. Weisz, Patrick J. McNamara, Amish Jain
Abstract
OBJECTIVE: To describe the clinical outcomes following treatment with vasopressin for a sub-cohort of critically ill preterm neonates who have refractory persistent pulmonary hypertension of the newborn (PPHN). DESIGN: Case series. SETTING: Tertiary neonatal intensive care unit, Toronto, Canada. POPULATION: Neonates born <37 weeks gestational age (GA) who received vasopressin for refractory PPHN (lack of response to inhaled nitric oxide) over a 4-year period. MEASUREMENTS: Changes in physiological indices of cardio-pulmonary stability during vasopressin therapy were analyzed using one-way repeated measures ANOVA, compared to pretreatment values. Data regarding survival to discharge and neurodevelopmental outcomes at 18-24 months were described. MAIN RESULTS: < .05 at 24 h vs. pretreatment). Oxygenation failure resolved in 8 cases, of which 7 patients survived (6 without disability). Among the 5 cases where oxygenation failure persisted despite vasopressin, 4 died while one survived with disability. CONCLUSIONS: Vasopressin offers promise as a therapy for preterm neonates with refractory PPHN and hemodynamic instability, but prospective investigation is needed.