Experience with terlipressin (TP) in the neonatal field is scarce. We describe the effects of TP on pulmonary circulation, studied with echocardiography, in an asphyxiated septic cooled infant with pulmonary hypertension (PH) who developed catecholamine-resistant hypotension and exacerbation of PH shortly after the beginning of the rewarming. TP was added to norephinephine and adrenaline infusions at the dose of 0.02 mg kg−1 every 6 h, because of refractory hypotension and oliguria. After 10 min, blood pressure dramatically and definitely increased, and urinary output was re-established after 60 min. Echocardiographic evaluation 30 min after the second bolus of TP showed unchanged velocity of the tricuspidal valve regurgitation and improved biventricular functional indexes respect to the pre-treatment assessment. TP was continued for 12 h (three doses) without significant adverse effect except for a transient increase in troponin levels. Addition of TP boluses to catecholamine infusion in our newborn was effective in increasing systemic vascular resistance without increasing pulmonary vascular resistance, successfully reversing the hemodynamics of severe PH, and suggesting a potential primary vasodilator effect on pulmonary circulation. Transient increase of troponin levels during TP treatment confirms the risk of excessive coronary vasoconstriction when TP boluses are added to high dose catecholamines.
This is a preview of subscription content, access via your institution
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Get just this article for as long as you need it
Prices may be subject to local taxes which are calculated during checkout
Morelli A, Ertmer C, Pietropaoli P, Westphal M . Terlipressin: a promising vasoactive agent in hemodynamic support of septic shock. Expert Opin Pharmacother 2009; 10: 2569–2575.
Gluud LL, Christensen K, Christensen E, Krag A . Systematic review of randomized trials on vasoconstrictor drugs for hepatorenal syndrome. Hepatology 2010; 51: 576–584.
Filippi L, Gozzini E, Daniotti M, Pagliai F, Catarzi S, Fiorini P . Rescue treatment with terlipressin in different scenarios of refractory hypotension in newborns and infants. Pediatr Crit Care Med 2011; 12: 1–5.
Filippi L, Poggi C, Serafini L, Fiorini P . Terlipressin as rescue treatment of refractory shock in a neonate. Acta Paediatr 2008; 97: 500–502.
Leone M, Martin C . Role of terlipressin in the treatment of infants and neonates with catecholamine-resistant septic shock. Best Pract Res Clin Anaesthesiol 2008; 22: 323–333.
Matok I, Leibovitch L, Vardi A, Adam M, Rubinshtein M, Barzilay Z et al. Terlipressin as rescue therapy for intractable hypotension during neonatal septic shock. Pediatr Crit Care Med 2004; 5: 116–118.
Papoff P, Caresta E, Versacci P, Grossi R, Midulla F, Moretti C . The role of terlipressin in the management of severe pulmonary hypertension in congenital diaphragmatic hernia. Pediatr Anesth 2009; 19: 805–806.
Stathopoulos L, Nicaise C, Michel F, Thomachot L, Merrot T, Lagier P et al. Terlipressin as rescue therapy for refractory pulmonary hypertension in a neonate with a congenital diaphragmatic hernia. J Pediatr Surg 2011; 46: E19–E21.
Pesaturo AB, Jennings HR, Voils SA . Terlipressin: vasopressin analog and novel drug for septic shock. Ann Pharmacother 2006; 40: 2170–2177.
Westphal M, Stubbe H, Sielenkämper AW, Borgulya R, Van Aken H, Ball C et al. Terlipressin dose response in healthy and endotoxemic sheep: impact on cardiopulmonary performance and global oxygen transport. Intensive Care Med 2003; 29: 301–308.
Westphal M, Stubbe H, Sielenkämper AW, Ball C, Van Aken H, Borgulya R et al. Effects of titrated arginine vasopressin on hemodynamic variables and oxygen transport in healthy and endotoxemic sheep. Crit Care Med 2003; 31: 1502–1508.
Albanèse J, Leone M, Delmas A, Martin C . Terlipressin or norepinephrine in hyperdynamic septic shock: a prospective, randomized study. Crit Care Med 2005; 33: 1897–1902.
Torgersen C, Dünser MW, Wenzel V, Jochberger S, Mayr V, Schmittinger CA et al. Comparing two different arginine vasopressin doses in advanced vasodilatory shock: a randomized, controlled, open-label trial. Intensive Care Med 2010; 36: 57–65.
Lange M, Ertmer C, Westphal M . Vasopressin vs. terlipressin in the treatment of cardiovascular failure in sepsis. Intensive Care Med 2008; 34: 821–832.
Scheurer MA, Scott MB, Atz AM . Vasopressin to attenuate pulmonary hypertension and improve systemic blood pressure after correction of obstructed total anomalous pulmonary venous return. J Thorac Cardiovasc Surg 2005; 129: 464–466.
Price LC, Forrest P, Sodhi V, Adamson DL, Nelson-Piercy C, Lucey M et al. Use of vasopressin after Caesarean section in idiopathic pulmonary arterial hypertension. Br J Anaesth 2007; 99: 552–555.
Kalambokis GN, Pappas K, Tsianos EV . Differential effects of terlipressin on pulmonary and systemic hemodynamics in patients with cirrhosis and pulmonary hypertension: an echo study. Angiology; e-pub ahead of print 6 July 2011.
Skinner JR, Boys RJ, Heads A, Hey EN, Hunter S . Estimation of pulmonary arterial pressure in the newborn: study of the repeatability of four Doppler echocardiographic techniques. Pediatr Cardiol 1996; 17: 360–369.
Chemla D, Lambert V, Losay J . Mean pulmonary artery pressure estimated from systolic and diastolic pulmonary artery pressure in children with congenital heart disease: an invasive study. Pediatr Cardiol 2009; 30: 1137–1142.
Kluckow M . Functional echocardiography in assessment of the cardiovascular system in asphyxiated neonates. J Pediatr 2011; 158: e13–e18.
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Radicioni, M., Troiani, S. & Camerini, P. Effects of terlipressin on pulmonary artery pressure in a septic cooled infant: an echocardiographic assessment. J Perinatol 32, 893–895 (2012). https://doi.org/10.1038/jp.2011.181
- hypertension pulmonary
- hypothermia induced
- infant newborn
- shock septic
This article is cited by
Utility of Low Dose Vasopressin for Persistent Pulmonary Hypertension of Newborn with Catecholamine Refractory Shock
Indian Journal of Pediatrics (2021)
Rescue Treatment with Terlipressin for Persistent Pulmonary Hypertension and Refractory Shock in a Preterm Infant
Indian Pediatrics (2020)
Vasopressin as an adjunct therapy for pulmonary hypertension: a case report
European Journal of Pediatrics (2014)
Reactions Weekly (2013)