Efficacy and Safety of Vasopressin and Terlipressin in Preterm Neonates: A Systematic Review

Abdulrahman Al-Saadi (), Katelyn Sushko, Vivian Bui, John van den Anker, Abdul Razak and Samira Samiee-Zafarghandy
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Abdulrahman Al-Saadi: Division of Neonatology, Department of Pediatrics, Sultan Qaboos University, Muscat 123, Oman
Katelyn Sushko: Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON L8S 4L8, Canada
Vivian Bui: Department of Pharmacy, Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
John van den Anker: Pediatric Pharmacology and Pharmacometrics, University Children’s Hospital Basel (UKBB), University of Basel, 4055 Basel, Switzerland
Abdul Razak: Division of Neonatology, Department of Pediatrics, King Abdullah bin Abdulaziz University Hospital, Princess Norah Bint Abdulrahman University, Riyadh 11564, Saudi Arabia
Samira Samiee-Zafarghandy: Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON L8S 4L8, Canada

IJERPH, 2022, vol. 19, issue 21, 1-20

Abstract: Introduction: The use of arginine vasopressin (AVP) and terlipressin to treat hypotension in preterm neonates is increasing. Our aim was to review the available evidence on the efficacy and safety of AVP and terlipressin for use in preterm neonates. Methods: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar from inception to September 2021 were searched for studies of AVP and terlipressin in the treatment of hypotension of any cause in preterm neonates. Primary outcomes were improvement in end-organ perfusion and mortality. The risk of bias assessment and certainty of the evidence were performed using appropriate tools. Results: Fifteen studies describing the use of AVP (n = 12) or terlipressin (n = 3) among 148 preterm neonates were included. Certainly, the available evidence for the primary outcome of end-organ perfusion rated as very low. AVP or terlipressin were used to treat 144 and 4 neonates, respectively. Improvement in markers of end-organ perfusion was reported in 143 (99%) neonates treated with AVP and 3 (75%) treated with terlipressin. The mortality rate was 41% (n = 59) and 50% (n = 2) for neonates who received AVP and terlipressin, respectively. Hyponatremia was the most frequently reported adverse event (n = 37, 25%). Conclusion: AVP and terlipressin may improve measured blood pressure values and possibly end-organ perfusion among neonates with refractory hypotension. However, the efficacy–safety balance of these drugs should be assessed on an individual basis and as per the underlying cause. Studies on the optimal dosing, efficacy, and safety of AVP and terlipressin in preterm neonates with variable underlying conditions are critically needed.

Keywords: preterm neonate; arginine vasopressin; terlipressin; hypotension (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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