Abstract
Vasopressin is emerging as a therapeutic adjunct option towards treatment of shock states in the pediatric population. Its effects on pulmonary vasculature are less well understood. This report describes a 5-month-old infant with nitric oxide-unresponsive pulmonary hypertension, oxygenation failure, and systemic hypotension. Vasopressin therapy improved oxygenation and blood pressure and biventricular function, allowing weaning of nitric oxide and inotropic support. No decrease in coronary flow was noted. Conclusions: Vasopressin could be considered as an adjunct option in infants with pulmonary hypertension and systemic hypotension. Echocardiographic monitoring during treatment is recommended.
Similar content being viewed by others
References
Biban P, Gaffuri M (2013) Vasopressin and terlipressin in neonates and children with refractory septic shock. Curr Drug Metab 14:186–192
Boyle WA III, Segel LD (1990) Attenuation of vasopressin-mediated coronary constriction and myocardial depression in the hypoxic heart. Circ Res 66:710–721
Bush A, Busst CM, Knight WB, Hislop AA, Haworth SG, Shinebourne EA (1990) Changes in pulmonary circulation in severe bronchopulmonary dysplasia. Arch Dis Child 65:739–745
Dunser MW, Mayr AJ, Stallinger A, Ulmer H, Ritsch N, Knotzer H, Pajk W, Mutz NJ, Hasibeder WR (2002) Cardiac performance during vasopressin infusion in postcardiotomy shock. Intensive Care Med 28:746–751
Evans NJ, Archer LN (1999) Doppler assessment of pulmonary artery pressure and extrapulmonary shunting in the acute phase of hyaline membrane disease. Arch Dis Child 66:6–11
Fouron JC, Le Guennec JC, Villemant D, Perreault G, Davignon A (1980) Value of echocardiography in assessing the outcome of bronchopulmonary dysplasia of the newborn. Pediatrics 65:529–535
Holmes CL, Walley KR, Chittock DR, Lehman T, Russell JA (2001) The effects of vasopressin on hemodynamics and renal function in severe septic shock: a case series. Intensive Care Med 27:1416–1421
Khemani E, McElhinney DB, Rhein L, Andrade O, Lacro RV, Thomas KC, Mullen MP (2007) Pulmonary artery hypertension in formerly premature infants with bronchopulmonary dysplasia: clinical features and outcomes in the surfactant era. Pediatrics 120:1260–1269
McNamara PJ, Laique F, Muang-In S, Whyte HE (2006) Milrinone improves oxygenation in neonates with severe persistent pulmonary hypertension of the newborn. J Crit Care 21(2):217–222
Mohamed A, Nasef N, Shah V, McNamara PJ (2013) Vasopressin as a rescue therapy for refractory pulmonary hypertension in neonates: case series. Pediatr Crit Care Med. doi:10.1097/PCC.0b013e31829f5fce
Musewe NN, Poppe D, Smallhorn JF, Hellman J, Whyte H, Smith B, Freedom RM (1990) Doppler echocardiographic measurement of pulmonary artery pressure from ductal Doppler velocities in the newborn. J Am Coll Cardiol 15:446–456
Nagamine Y, Hara M (2012) Intravenous arginine vasopressin for two pediatric cases of pulmonary hypertension after congenital heart surgery. Masui 61(10):1112–1116
Okamura T, Ayajiki K, Fujioka H, Toda N (1999) Mechanisms underlying arginine vasopressin-induced relaxation in monkey isolated coronary arteries. J Hypertens 17:673–678
Patel BM, Chittock DR, Russell JA, Walley KR (2002) Beneficial effects of short-term vasopressin infusion during severe septic shock. Anesthesiology 96:576–582
Radicioni M, Troiani S, Camerini PG (2012) Effects of terlipressin on pulmonary artery pressure in a septic cooled infant: an echocardiographic assessment. J Perinatol 32(11):893–895
Slaughter JL, Pakrashi T, Jones DE, South AP, Shah TA (2011) Echocardiographic detection of pulmonary hypertension in extremely low birth weight infants with bronchopulmonary dysplasia requiring prolonged positive pressure ventilation. J Perinatol 31:635–640
Stathopoulos L, Nicaise C, Michel F, Thomachot L, Merrot T, Lagier P, Martin C (2011) Terlipressin as rescue therapy for refractory pulmonary hypertension in a neonate with a congenital diaphragmatic hernia. Pediatr Surg 46(2):e19–e21
Thibonnier M, Conarty DM, Preston JA, Plesnicher CL, Dweik RA, Erzurum SC (1999) Human vascular endothelial cells express oxytocin receptors. Endocrinology 140:1301–1309
Conflict of interest
There is no financial relationship with the organization that sponsored the research.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Malikiwi, A., Sasi, A., Tan, K. et al. Vasopressin as an adjunct therapy for pulmonary hypertension: a case report. Eur J Pediatr 173, 1651–1654 (2014). https://doi.org/10.1007/s00431-013-2225-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-013-2225-y