The effect of norepinephrine on clinical and hemodynamic parameters in neonates with shock: a retrospective cohort study.

Abstract

changes in mean blood pressure (MBP) at 6, 12, and 24h post-initiation of NE. Changes in (i) diastolic BP, systolic BP, and vasoactive inotrope score (VIS) at 6, 12, and 24h, (ii) urine output after initiation of NE ii) pH, lactate, fraction of inspired oxygen (FiO2) after initiation of NE, and (iv) adverse outcomes. Fifty infants received NE with mean (SD) gestational age of 34.3 (4.3) weeks and a mean birth weight of 2215 (911) g. Treatment began at a median age of 36 (IQR: 15.2, 67.2) hours of life and lasted 30.5 (IQR: 12.7, 58) hours. MBP improved from 34.4mm Hg (SD: 6.6) at baseline to 39.4mm Hg (SD: 10.5, p < 0.001) at 6h, to 39.6mm Hg (SD: 12.1, p = 0.002) at 12h and to 40.4mm Hg (SD: 15.5, p = 0.004) at 24h after NE initiation. Vasoactive inotrope score declined from 30 (20, 32) to 10 (4, 30; p < 0.001) at 24h. Urine output improved within 24h [1.5ml/kg/h (0.5, 2.3) at baseline to 3 (1.9, 4.3) at 24h; p = 0.04]. Oxygen requirement decreased after NE initiation. The use of NE appears to be effective and safe for treating systemic hypotension in neonates. Being a retrospective study, trial registration was not considered. •Dopamine has traditionally been used as the initial agent for treatment of neonatal hypotension. •Norepinephrine has recently been recommended as the first-choice vasopressor agent to correct hypotension in adults and pediatric patients, with insufficient data on the cardiovascular effects of NE in neonates What is new: •Mean blood pressure improved significantly at 6, 12, and 24h with reduction in vasoactive infusion score at 12 and 24h after norepinephrine infusion. •No significant change in heart rate or abnormal abdominal adverse effects noted in this study.