• Sascha Meyer, Sven Gottschling, Ali Baghai, Donald Wurm, and Ludwig Gortner.
• Department of Neonatology and Pediatric Intensive Care, University Children's Hospital of Saarland, 66421 Homburg, Germany. sascha.meyer@uniklinikum-saarland.de
• Crit Care. 2006 Jan 1;10(3):R71.

IntroductionThe aim of this study was to assess the efficacy of arginine-vasopressin (AVP) as a rescue therapy in catecholamine-refractory septic and non-septic shock in extremely low birth weight (ELBW) infants with acute renal injury.MethodsProspective assessment of AVP therapy in three ELBW infants with catecholamine-refractory septic shock and acute renal injury (mean birth weight 600 +/- 30 g) and three ELBW infants with non-septic shock and acute renal injury (mean birth weight 770 +/- 110 g) at a University hospital. The main outcome measures were restoration of blood pressure with adequate organ perfusion and survival at discharge.ResultsIn all three ELBW infants with catecholamine-resistant septic shock, systemic arterial blood pressure increased substantively with restoration of urine output after AVP administration (dosage, 0.035 to 0.36 U/kg/h; length, 70 +/- 21 hours). In the three ELBW infants with non-septic shock, only a transient stabilization in mean arterial pressure with restoration of urine output was observed after AVP therapy (dosage, 0.01 to 0.36 U/kg/h; length, 30 +/- 16 hours). The mortality rate was 1/3 in the sepsis group versus 3/3 in the non-septic group.ConclusionAVP may be a promising rescue therapy in catecholamine-resistant shock in ELBW infants with acute renal injury. Larger prospective clinical trials are warranted to assess the efficacy and safety of AVP as a pressor adjunct in septic versus non-septic shock in ELBW infants.

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