Terlipressin as rescue therapy for intractable hypotension during neonatal septic shock

OBJECTIVE: To report the successful use of terlipressin in an 8-day-old infant for treatment of intractable hypotension caused by septic shock.

DESIGN: Descriptive case report.

SETTING: An 18-bed pediatric intensive care unit at a tertiary care children's hospital.

PATIENT: An 8-day-old child with intractable hypotension due to septic shock after heart surgery.

INTERVENTIONS: General supportive intensive care including mechanical ventilatory support, volume replacement, and inotropic support with dopamine 20 microg.kg(-1).min(-1), milrinone 0.75 microg.kg(-1).min(-1), and epinephrine 0.8 microg.kg(-1).min(-1).

MEASUREMENTS AND MAIN RESULTS: Terlipressin (7 microg/kg per dose twice daily) was added as rescue therapy because of profound intractable hypotension. Shortly after the beginning of treatment, blood pressure and perfusion dramatically improved.

CONCLUSIONS: There is circumstantial evidence that the administration of terlipressin caused the increase in blood pressure. We suggest that terlipressin should be considered as rescue therapy when high-dose catecholamine therapy does not result in sufficient perfusion pressure. Further investigation is needed to prove terlipressin's effectiveness and safety in infants and children.