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. 2023 Mar 29:11:1104728.
doi: 10.3389/fped.2023.1104728. eCollection 2023.

Early vasopressin infusion improves oxygenation in infants with congenital diaphragmatic hernia

Irma Capolupo  1 , Domenico Umberto De Rose  1 , Francesca Mazzeo  1 , Francesca Monaco  1 , Paola Giliberti  1 , Francesca Landolfo  1 , Alessandra Di Pede  1 , Alessandra Toscano  2 , Andrea Conforti  3 , Pietro Bagolan  3   4 , Andrea Dotta  1
Affiliations

Early vasopressin infusion improves oxygenation in infants with congenital diaphragmatic hernia

Irma Capolupo et al. Front Pediatr. .

Abstract

Objective: Congenital Diaphragmatic Hernia (CDH) is a complex disease including a diaphragmatic defect, lung hypoplasia, and pulmonary hypertension. Despite its increasing use in neonates, the literature on the use of vasopressin in neonates is limited. The aim of this work is to analyze the changes in clinical and hemodynamic variables in a cohort of CDH infants treated with vasopressin.

Methods: Among CDH infants managed at the Neonatal Intensive Care Unit (NICU) of our hospital from May 2014 to January 2019, all infants who were treated with vasopressin, because of systemic hypotension and pulmonary hypertension, were enrolled in this retrospective study. The primary outcome was the change in oxygenation index (OI) after the start of the infusion of vasopressin. The secondary outcomes were the changes in cerebral and splanchnic fractional tissue oxygen extraction (FTOEc and FTOEs) at near-infrared spectroscopy, to understand the balance between oxygen supply and tissue oxygen consumption after the start of vasopressin infusion. We also reported as secondary outcomes the changes in ratio of arterial oxygen partial pressure (PaO2) to fraction of inspired oxygen (FiO2), heart rate, mean arterial pressure, serum pH, and serum sodium.

Results: We included 27 patients with isolated CDH who received vasopressin administration. OI dramatically dropped when vasopressin infusion started, with a significant reduction according to ANOVA for repeated measures (p = 0.003). A global significant improvement in FTOEc and FTOEs was detected (p = 0.009 and p = 0.004, respectively) as a significant reduction in heart rate (p = 0.019). A global significant improvement in PaO2/FiO2 ratio was observed (p < 0.001) and also at all time points: at 6 h since infusion (p = 0.015), 12 h (p = 0.009), and 24 h (p = 0.006), respectively. A significant reduction in sodium levels was observed as expected side effect (p = 0.012). No significant changes were observed in the remaining outcomes.

Conclusion: Our data suggest that starting early vasopressin infusion in CDH infants with pulmonary hypertension could improve oxygenation index and near-infrared spectroscopy after 12 and 24 h of infusion. These pilot data represent a background for planning future larger randomized trials to evaluate the efficacy and safety of vasopressin for the CDH population.

Keywords: CDH; NIRS; hypotension; near-infrared spectroscopy; neonates; oxygenation index; pulmonary hypertension.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow-chart of the design of the study.
Figure 2
Figure 2
Changes in oxygenation Index (OI) before and after vasopressin infusion: the line shows the trend of median values. T0: before vasopressin infusion; T1: after 6 h from the start of infusion; T2: after 12 h from the start of infusion; T3: after 24 h from the start of infusion.
Figure 3
Figure 3
Percentage of CDH infants with mild, moderate, and severe PH before (A) and after (B) 24 h of vasopressin infusion at echocardiographic evaluation.
Figure 4
Figure 4
Changes in oxygenation index (OI) before and after vasopressin infusion, with medians and IQR bars. T0: before vasopressin infusion; T1: after 6 h from the start of infusion; T2: after 12 h from the start of infusion; T3: after 24 h from the start of infusion.
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