103 Use of vasopressin and norepinephrine in neonatal septic shock- A multi centre retrospective cohort study
Bibliographic record
Abstract
Abstract Background Vasopressin (VA) and norepinephrine (NE) are pressors that are increasingly being used in neonates. More recently, there has been wider application of NE in the management of neonatal warm septic shock. While biological rationale is sound given the speculation of low VA levels in septic sate, use of VA in septic shock remains underexplored in neonates. Objectives To describes the utilization of VA and NE in neonates with warm septic shock, focusing on their effects on physiological indices of cardiorespiratory stability and overall outcomes across three tertiary Neonatal Intensive Care Unit (NICU) in Canada. Design/Methods This was a retrospective study that involved neonates with warm septic shock who received VA or NE between Jan 2015-Dec 2020 at 3 Canadian level-III NICU. Receipt of both VA and NE were excluded. Data was collected from medical records on demographic information, dosing details, cardiorespiratory parameters and clinical outcomes. Independent t-tests (or Mann-Whitney U tests) and chi-square tests (or Fisher’s exact tests) were used to compare groups for continuous and categorical variables, respectively; repeated measures analysis of variance were used to examine trends in physiological parameters over time between groups. Results 58 neonates (VA: 21, NE: 37) were included in this analysis. Mean gestational age (GA) and birth weight were significantly higher in VA group compared to NE group- mean GA (SD) in weeks was 27.1 (4.1) in VA group and 24.9 (2.8) in NE group, p= 0.015 (Table 1). VA was used more frequently as a second line agent in 57.1%, while NE as first line agent in 62.2%, p=0.016. Notably, VA neonates had significantly higher mean FiO2 (SD) at initiation compared to NE group (71.1[34.1] Vs 47.5[24.5], p 0.026) with earlier postnatal age for its use (8.4[7.2] Vs 13.7[9.1] days, p=0.025). Enhancement in physiological parameters were observed over the course of treatment with both agents as shown in Figure 1, with similar treatment response to each agent. Mortality within the first 7 days of use was 38.1% (n=8) and 27% (n=10), p=0.381 in the VA and NE group, respectively. Median length of hospital stay (IQR) was significantly shorter in VA group at 21 (11-38) days compared to NE group at 56 (24-126) days. Other outcomes were comparable between groups (Table 1). Conclusion This study describes the use of VA and NE- two uniquely distinct pressors- in neonatal septic shock, providing pragmatic insights into its use. While use of VA in septic shock looks promising, further prospective studies exploring its use as first line agent in septic shock and further detailing its cardiopulmonary effects and safety profiles are warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".