Skip to main content
×
Home

The use of Arginine Vasopressin in neonates following the Norwood procedure

  • Grant L. Burton (a1), Jon Kaufman (a1), Benjamin H. Goot (a2) and Eduardo M. da Cruz (a1)
Abstract
AbstractBackground

Following the Norwood palliation, neonates may require an escalation of inotropic and vasoactive support. Arginine Vasopressin may be uniquely useful in supporting this population.

Materials and Methods

A retrospective evaluation of neonates at this institution between November, 2007 and October, 2010 who received Arginine Vasopressin following the Norwood procedure. Data were recorded from the patient records at one hour prior to, and then 1, 2, 3, 4, 6, and 24 hours following Arginine Vasopressin initiation.

Results

We included 28 neonates. The mean dose of Arginine Vasopressin was 0.0005 plus or minus 0.0003 units per kilogram per minute. There was an early response (less than 6 hours) characterised by an 8% increase in systolic blood pressure (p = 0.0004), a 100% increase in urine output (p = 0.02), and a 29% decrease in total fluid administration (p = 0.04). The late response (at 24 hours) revealed further increases in systolic blood pressure and urine output as well as a 53% decrease in serum lactate (p = 0.007) and increase in arterial pH from 7.36 to 7.45 (p less than 0.0001). These changes were not accompanied by increases in heart rate or inotrope score.

Conclusions

The initiation of Arginine Vasopressin in post-operative Norwood patients was temporally associated with an improvement in markers of perfusion including systolic blood pressure, urine output, lactate, and pH. Further studies are required to ascertain the efficacy of Arginine Vasopressin in this population.

Copyright
Corresponding author
Correspondence to: E. M. da Cruz, MD, Professor of Pediatrics, The Children's Hospital, University of Colorado at Denver, School of Medicine, 13121 East 16th Avenue, B-100, Aurora, CO 80045, United States of America. Tel: +1 720 777 6992; Fax: +1 720 777 7290; E-mail: dacruz.eduardo@tchden.org
References
Hide All
1.Hoffman GM, Tweddell JS, Ghanayem NS, et al. Alteration of the critical arteriovenous oxygen saturation relationship by sustained afterload reduction after the norwood procedure. J Thorac Cardiovasc Surg 2004; 127: 738745.
2.De Oliveira NC, Ashburn DA, Khalid F, et al. Prevention of early sudden circulatory collapse after the norwood operation. Circulation 2004; 110: II133II138.
3.Thibonnier M. Signal transduction of v1-vascular vasopressin receptors. Regul Pept 1992; 38: 111.
4.Mastropietro CW, Clark JA, Delius RE, et al. Arginine vasopressin to manage hypoxemic infants after stage i palliation of single ventricle lesions. Pediatr Crit Care Med 2008; 9: 506510.
5.Zingg HH. Vasopressin and oxytocin receptors. Baillieres Clin Endocrinol Metab 1996; 10: 7596.
6.Schafer JA, Hawk CT. Regulation of Na+ channels in the cortical collecting duct by avp and mineralocorticoids. Kidney Int 1992; 41: 255268.
7.Gutkowska J, Jankowski M, Lambert C, et al. Oxytocin releases atrial natriuretic peptide by combining with oxytocin receptors in the heart. Proc Natl Acad Sci U S A 1997; 94: 1170411709.
8.Boarder MR, Weisman GA, Turner JT, et al. G protein-coupled p2 purinoceptors: From molecular biology to functional responses. Trends Pharmacol Sci 1995; 16: 133139.
9.Zenteno-Savin T, Sada-Ovalle I, Ceballos G, et al. Effects of arginine vasopressin in the heart are mediated by specific intravascular endothelial receptors. Eur J Pharmacol 2000; 410: 1523.
10.Maybauer MO, Maybauer DM, Enkhbaatar P, et al. Physiology of the vasopressin receptors. Best Pract Res Clin Anaesthesiol 2008; 22: 253263.
11.Mei Q, Liang BT. P2 purinergic receptor activation enhances cardiac contractility in isolated rat and mouse hearts. Am J Physiol Heart Circ Physiol 2001; 281: H334H341.
12.Wernovsky G, Wypij D, Jonas RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 1995; 92: 22262235.
13.Rostron AJ, Avlonitis VS, Cork DM, et al. Hemodynamic resuscitation with arginine vasopressin reduces lung injury after brain death in the transplant donor. Transplantation 2008; 85: 597606.
14.Mastropietro CW, Rossi NF, Clark JA, et al. Relative deficiency of arginine vasopressin in children after cardiopulmonary bypass. Crit Care Med 2010; 38: 20522058.
15.Choong K, Bohn D, Fraser DD, et al. Vasopressin in pediatric vasodilatory shock: a multicenter randomized controlled trial. Am J Respir Crit Care Med 2009; 180: 632639.
16.Rosenzweig EB, Starc TJ, Chen JM, et al. Intravenous arginine-vasopressin in children with vasodilatory shock after cardiac surgery. Circulation 1999; 100: II182II186.
17.Lechner E, Hofer A, Mair R, et al. Arginine-vasopressin in neonates with vasodilatory shock after cardiopulmonary bypass. Eur J Pediatr 2007; 166: 12211227.
18.Matok I, Rubinshtein M, Levy A, et al. Terlipressin for children with extremely low cardiac output after open heart surgery. Ann Pharmacother 2009; 43: 423429.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Full text views

Total number of HTML views: 1
Total number of PDF views: 15 *
Loading metrics...

Abstract views

Total abstract views: 173 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 20th November 2017. This data will be updated every 24 hours.