Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical Research Article
  • Published:

Vasopressin in newborns with refractory acute pulmonary hypertension

Pediatric Research (2024)Cite this article

Abstract

Background

Acute pulmonary hypertension (aPH) in newborns can be life threatening and challenging to manage. In newborns with refractory aPH, there is currently limited therapeutic agents.

Methods

Retrospective single-center cohort study in newborns less than one month old who were treated with vasopressin for a minimum of one hour in the context of refractory aPH in the neonatal and pediatric intensive care units of a tertiary university center between 2016 and 2022. The objective was to evaluate the efficacy and safety of vasopressin in newborns as an adjuvant treatment for refractory aPH.

Results

Twenty-five patients met inclusion criteria. In patients who received vasopressin, oxygenation index improved from 28.4 to 14.4 (p = 0.004) after twelve hours of continuous infusion. Oxygen requirements (FiO2) decreased from 0.91 to 0.50 (p = 0.004) and mean arterial pressure increased from 41 to 51 mmHg (p = 0.001). In our cohort, 68% of patients presented an episode of hyponatremia (serum sodium <130 mmol/L).

Conclusions

The use of vasopressin may be associated with improvement in oxygenation and hemodynamic status of neonatal patients with aPH refractory to initial therapy. Further prospective studies are needed to establish the safety profile of vasopressin in newborns, particularly in preterm infants.

Impact

  • Vasopressin may be an effective cardiotropic agent to improve oxygenation and hemodynamic status in newborns with acute pulmonary hypertension.

  • Careful monitoring of serum sodium levels are warranted in newborns who are receiving vasopressin infusion.

  • This provides additional evidence for the consideration of vasopressin in newborns with acute pulmonary hypertension refractory to inhaled nitric oxide.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

Data availability

The datasets generated during and/or analysed during the current study are available from corresponding author on reasonable request.

References

  1. Walsh-Sukys, M. C. et al. Persistent pulmonary hypertension of the newborn in the era before nitric oxide: practice variation and outcomes. Pediatrics 105, 14–20 (2000).

    Article  CAS  PubMed  Google Scholar 

  2. Mohamed, A. A. et al. Vasopressin for refractory persistent pulmonary hypertension of the newborn in preterm neonates-a case series. Published online. https://doi.org/10.1080/14767058.2020.1757642/format/epub/EPUB/xhtml/index.xhtml (2020).

  3. Gomella, T. L., Eyal, F. G. & Bany-Mohammed, F. Gomella’s Neonatalogy 8th edn, Vol 1 (Gomella T. L., ed.) (Mc Graw Hill Lange, 2020).

  4. Baczynski, M. et al. Short-term and long-term outcomes of preterm neonates with acute severe pulmonary hypertension following rescue treatment with inhaled nitric oxide. Arch. Dis. Child Fetal Neonatal Ed. 102, F508–F514 (2017).

    Article  PubMed  Google Scholar 

  5. Konduri, G. G. et al. Early inhaled nitric oxide therapy for term and near-term newborn infants with hypoxic respiratory failure: neurodevelopmental follow-up. J. Pediatr. 150, 235–240.e1 (2007).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Shivananda, S. et al. Variation in the management of persistent pulmonary hypertension of the newborn: a survey of physicians in Canada, Australia, and New Zealand. Am. J. Perinatol. 29, 519–525 (2012).

    PubMed  Google Scholar 

  7. Siehr, S. L. et al. Hemodynamic effects of phenylephrine, vasopressin, and epinephrine in children with pulmonary hypertension: a pilot study. Pediatr. Crit. Care Med. 17, 428–437 (2016).

    Article  PubMed  Google Scholar 

  8. Lechner, E. et al. Arginine-vasopressin in neonates with vasodilatory shock after cardiopulmonary bypass. Eur. J. Pediatr. 166, 1221–1227 (2007).

    Article  CAS  PubMed  Google Scholar 

  9. Meyer, S., Gottschling, S., Baghai, A., Wurm, D. & Gortner, L. Arginine-vasopressin in catecholamine-refractory septic versus non-septic shock in extremely low birth weight infants with acute renal injury. Crit. Care 10, R71 (2006).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Matok, I. et al. Terlipressin as rescue therapy for intractable hypotension due to septic shock in children. Shock 23, 305–310 (2005).

    Article  CAS  PubMed  Google Scholar 

  11. Bidegain, M. et al. Vasopressin for refractory hypotension in extremely low birth weight infants. J. Pediatr. 157, 502–504 (2010).

    Article  PubMed  PubMed Central  Google Scholar 

  12. Rios, D. R. & Kaiser, J. R. Vasopressin versus dopamine for treatment of hypotension in extremely low birth weight infants: a randomized, blinded pilot study. J. Pediatr. 166, 850–855 (2015).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Alsaadi, A. S. et al. Efficacy and safety of vasopressin and terlipressin in preterm neonates: a protocol for a systematic review. BMJ Paediatr. Open. 5. https://doi.org/10.1136/bmjpo-2021-001067 (2021).

  14. Mohamed, A. A. et al. Vasopressin for refractory persistent pulmonary hypertension of the newborn in preterm neonates–a case series. J. Matern.-Fetal Neonatal Med. 35, 1475–1483 (2022).

    Article  CAS  PubMed  Google Scholar 

  15. Stathopoulos, L. et al. Terlipressin as rescue therapy for refractory pulmonary hypertension in a neonate with a congenital diaphragmatic hernia. J. Pediatr. Surg. 46. https://doi.org/10.1016/j.jpedsurg.2010.10.006 (2011).

  16. Malikiwi, A., Sasi, A., Tan, K. & Sehgal, A. Vasopressin as an adjunct therapy for pulmonary hypertension: a case report. Eur. J. Pediatr. 173, 1651–1654 (2014).

    Article  PubMed  Google Scholar 

  17. Budniok, T., Elsayed, Y. & Louis, D. Effect of vasopressin on systemic and pulmonary hemodynamics in neonates. Am. J. Perinatol. 38, 1330–1334 (2021).

    Article  PubMed  Google Scholar 

  18. Mohamed, A., Nasef, N., Shah, V. & McNamara, P. J. Vasopressin as a rescue therapy for refractory pulmonary hypertension in neonates: case series. Pediatr. Crit. Care Med. 15, 148–154 (2014).

    Article  PubMed  Google Scholar 

  19. Ranjan, A., Sundaram, V., Taneja, M. & Dutta, S. Severe neonatal pulmonary artery hypertension rescued with vasopressin. BMJ Case Rep. 14. https://doi.org/10.1136/bcr-2020-240360 (2021).

  20. Shah, S., Dhalait, S., Fursule, A., Khandare, J. & Kaul, A. Use of vasopressin as rescue therapy in refractory hypoxia and refractory systemic hypotension in term neonates with severe persistent pulmonary hypertension-a prospective observational study. Am. J. Perinatol. 2022. https://doi.org/10.1055/a-1969-1119.

  21. McNamara, P. J., Giesinger, R. E. & Lakshminrusimha, S. Dopamine and neonatal pulmonary hypertension-pressing need for a better pressor? J. Pediatr. 246, 242–250 (2022).

    Article  CAS  PubMed  Google Scholar 

  22. Wenzel, V. et al. Repeated administration of vasopressin but not epinephrine maintains coronary perfusion pressure after early and late administration during prolonged cardiopulmonary resuscitation in pigs. Circulation 99, 1379–1384 (1999).

    Article  CAS  PubMed  Google Scholar 

  23. Krismer, A. C. et al. Cardiopulmonary resuscitation during severe hypothermia in pigs: does epinephrine or vasopressin increase coronary perfusion pressure? Anesth. Analg. 90, 69–73 (2000).

    Article  CAS  PubMed  Google Scholar 

  24. Jin, H. K. et al. Hemodynamic effects of arginine vasopressin in rats adapted to chronic hypoxia. J. Appl Physiol. 66, 151–160 (1989).

    Article  CAS  PubMed  Google Scholar 

  25. Sugawara, Y., Mizuno, Y., Oku, S. & Goto, T. Effects of vasopressin during a pulmonary hypertensive crisis induced by acute hypoxia in a rat model of pulmonary hypertension. Br. J. Anaesth. 122, 437–447 (2019).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Lakshminrusimha, S. et al. Superoxide dismutase improves oxygenation and reduces oxidation in neonatal pulmonary hypertension. Am. J. Respir. Crit. Care Med. 174, 1370–1377 (2006).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Nakwan, N. & Chaiwiriyawong, P. An international survey on persistent pulmonary hypertension of the newborn: a need for an evidence-based management. J. Neonatal Perinat. Med. 9, 243–250 (2016).

    Article  CAS  Google Scholar 

  28. Jain, A. et al. Care of the critically ill neonate with hypoxemic respiratory failure and acute pulmonary hypertension: framework for practice based on consensus opinion of neonatal hemodynamics working group. J. Perinatol. 42, 3–13 (2022).

    Article  PubMed  Google Scholar 

  29. Salazar, M., Hu, B. B., Vazquez, J., Wintz, R. L. & Varon, J. Exogenous vasopressin-induced hyponatremia in patients with vasodilatory shock: two case reports and literature review. J. Intens. Care Med. 30, 253–258 (2015).

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the Department of Pharmacy and the Department of Pediatrics of the Center Mère-Enfant Soleil for their support in carrying out this study, Mahukpe Narcisse Ulrich Singbo for the statistical analysis and the Plateforme de la recherche Clinique at CHU de Quebec. Funding for statistical support was provided from Centre de recherche clinique du CHU de Québec.

Author information

Authors and Affiliations

  1. Department of Pediatrics, CHU de Québec, Université Laval, Quebec City, Canada

    Simon Ouellet, Christine Drolet, Geneviève Morissette & Audrey Hébert

  2. Division of Neonatology, CHU de Québec, Université Laval, Quebec City, Canada

    Christine Drolet & Audrey Hébert

  3. Division of Pediatric Intensive Care, CHU de Québec, Université Laval, Quebec City, Canada

    Geneviève Morissette

  4. Department of Pharmacy, CHU de Québec, Université Laval, Quebec City, Canada

    Annie Pellerin

Authors
  1. Simon Ouellet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christine Drolet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Geneviève Morissette
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Annie Pellerin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Audrey Hébert
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Each author has met the Pediatric Research authorship requirements. S.O. contributed to conception and design, acquisition of data, analysis and interpretation of data, drafting of the article and final approval of the version to be published. C.D. contributed to conception and design, drafting of the article and final approval of the version to be published. G.M. contributed to conception and design, drafting of the article and final approval of the version to be published A.P. contributed to conception and design, drafting of the article and final approval of the version to be published. A.H. contributed to conception and design, drafting of the article and final approval of the version to be published.

Corresponding author

Correspondence to Audrey Hébert.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ouellet, S., Drolet, C., Morissette, G. et al. Vasopressin in newborns with refractory acute pulmonary hypertension. Pediatr Res (2024). https://doi.org/10.1038/s41390-023-02995-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41390-023-02995-3

Search

Advanced search

Quick links