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The use of Arginine Vasopressin in neonates following the Norwood procedure

Published online by Cambridge University Press:  19 April 2011

Grant L. Burton ,
Jon Kaufman ,
Benjamin H. Goot  and
Eduardo M. da Cruz
Grant L. Burton
Affiliation:
Department of Pediatrics, Section of Pediatric Cardiac Intensive Care, The Children's Hospital, The Heart Institute, Aurora, Colorado, United States of America
Jon Kaufman
Affiliation:
Department of Pediatrics, Section of Pediatric Cardiac Intensive Care, The Children's Hospital, The Heart Institute, Aurora, Colorado, United States of America
Benjamin H. Goot
Affiliation:
Service of General Pediatrics, Department of Pediatrics, The Children's Hospital, School of Medicine, University of Colorado at Denver, Aurora, Colorado, United States of America
Eduardo M. da Cruz*
Affiliation:
Department of Pediatrics, Section of Pediatric Cardiac Intensive Care, The Children's Hospital, The Heart Institute, Aurora, Colorado, United States of America
*
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: [email protected]
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Abstract

Background

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.

Keywords

Arginine Vasopressinneonatecongenital cardiac surgeryshockhypoplastic left heart syndrome
Type
Original Articles
Information
Cardiology in the Young , Volume 21 , Issue 5 , 09 September 2011 , pp. 536 - 544
Copyright
Copyright © Cambridge University Press 2011

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References

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: 738–745.CrossRefGoogle ScholarPubMed
2.De Oliveira, NC, Ashburn, DA, Khalid, F, et al. Prevention of early sudden circulatory collapse after the norwood operation. Circulation 2004; 110: II133–II138.CrossRefGoogle ScholarPubMed
3.Thibonnier, M. Signal transduction of v1-vascular vasopressin receptors. Regul Pept 1992; 38: 1–11.CrossRefGoogle ScholarPubMed
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: 506–510.CrossRefGoogle Scholar
5.Zingg, HH. Vasopressin and oxytocin receptors. Baillieres Clin Endocrinol Metab 1996; 10: 75–96.CrossRefGoogle ScholarPubMed
6.Schafer, JA, Hawk, CT. Regulation of Na+ channels in the cortical collecting duct by avp and mineralocorticoids. Kidney Int 1992; 41: 255–268.CrossRefGoogle ScholarPubMed
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: 11704–11709.CrossRefGoogle ScholarPubMed
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: 133–139.CrossRefGoogle ScholarPubMed
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: 15–23.CrossRefGoogle ScholarPubMed
10.Maybauer, MO, Maybauer, DM, Enkhbaatar, P, et al. Physiology of the vasopressin receptors. Best Pract Res Clin Anaesthesiol 2008; 22: 253–263.CrossRefGoogle ScholarPubMed
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: H334–H341.CrossRefGoogle ScholarPubMed
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: 2226–2235.CrossRefGoogle ScholarPubMed
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: 597–606.CrossRefGoogle ScholarPubMed
14.Mastropietro, CW, Rossi, NF, Clark, JA, et al. Relative deficiency of arginine vasopressin in children after cardiopulmonary bypass. Crit Care Med 2010; 38: 2052–2058.CrossRefGoogle ScholarPubMed
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: 632–639.CrossRefGoogle Scholar
16.Rosenzweig, EB, Starc, TJ, Chen, JM, et al. Intravenous arginine-vasopressin in children with vasodilatory shock after cardiac surgery. Circulation 1999; 100: II182–II186.CrossRefGoogle ScholarPubMed
17.Lechner, E, Hofer, A, Mair, R, et al. Arginine-vasopressin in neonates with vasodilatory shock after cardiopulmonary bypass. Eur J Pediatr 2007; 166: 1221–1227.CrossRefGoogle ScholarPubMed
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: 423–429.CrossRefGoogle ScholarPubMed