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Table 1 Patient characteristics and clinical details

From: Arginine-vasopressin in catecholamine-refractory septic versus non-septic shock in extremely low birth weight infants with acute renal injury

Patient

Age (gender)/birth weight/APGAR score

Underlying disease/treatment

Cause/time of onset of shock

Urine output/Increase in serum creatinine/Serum lactate prior to AVP

Echocardiography

Dosage/duration of AVP

NE/E prior to AVP

Further NE/E

Clinical outcome/complications

1

24 + 6 wks (F); caesarean delivery; 600 g APGAR: 7/9/9

RDS, PDA Mechanical ventilation Surgical closure of PDA

Klebsiella pneumoniae sepsis 10th day of life

0.2 ml/kg/h 2.3 times 8.5 mmol/l

SF: 34–38%

After an initial bolus of 0.025 U, 0.035 U/kg/h 36 hours

NE: 0.5 μg/kg/minute E: 0.5 μg/kg/minute

Continuation of NE/E over 28 hours after cessation of AVP therapy in decreasing dosage

Survived; BPD; ROP II; Two cystic lesions (occipital and periventricular; 3–4 mm in diameter) most probably residues from intracranial hemorrhage

2

26 + 5 wks (F); caesarean delivery; 660 g APGAR: 3/7/8

RDS, PDA Mechanical ventilation Surgical closure of PDA

Candida parapsilosis sepsis 12th day of life

0.1 ml/kg/h 2.1 times 14.4 mmol/

SF: 33–36%

0.10 U/kg/h 118 hours

NE: 0.5 μg/kg/minute E: 0.5 μg/kg/minute

Continuation of NE/E over 20 h after cessation of AVP therapy in decreasing dosage

Survived; BPD; bilateral intraventricular hemorrhage without developing hydrocephalus; ROP I; no ischemic lesions secondary to AVP therapy

3

27 + 6 wks (M); caesarean delivery; 550 g APGAR: 6/7/7

RDS, prior acute renal injury possibly related to indomethacin administration Mechanical ventilation

E. coli/Staph. epidermidis sepsis 5th week of life

0.2 ml/kg/h 1.5 times 5.2 mmol/l

SF: 35–36%

Initially 0.12 U/kg/h, increased to 0.36/U/kg/h 85 hours

NE: 0.5–1.0 μg/kg/h E: 0.5–1.0 μg/kg/h

Continuation of NE/E over the next 6 days after cessation of AVP therapy in increasing dosages

Recurrent episode of acute renal injury; died; autopsy showed severe RDS; no ischemic lesions secondary to AVP therapy

4

Twin I: 26 + 1 wks (M); spontaneous vaginal delivery; 890 g APGAR: 4/7/8

RDS Progressive left ventricular dilatation Hyperkalemia Pneumothorax HFOV Drainage of pneumothoraces Intravenous calcium, β2-mimetics, insulin

Low-cardiac output failure 3rd day of life

0.2 ml/kg/h 2.0 times 14.9 mmol/l

SF: 15–20% 1st to 2nd degree mitral valve insufficiency PDA ruled out

Initially 0.01 U/kg/h, increased to 0.1 U/kg/h 21 hours

NE: 1.5 μg/kg/minute E: 1.5 μg/kg/minute

Despite AVP increased demand for catecholamines (NE/E: 3 μg/kg/minute)

Died after 21 hours of AVP therapy of cardio-respiratory failure; no ischemic lesions secondary to AVP therapy. A congenital cardiac malformation and cardiomyopathy were ruled out by autopsy

5

Twin II: 26+1 wks (M); spontaneous vaginal delivery; 880 g APGAR: 6/7/7

PIE Progressive left ventricular dilatation Hyperkalemia HFOV Intravenous calcium, β2-mimetics, insulin

Low-cardiac output failure 3rd day of life

0.4 ml/kg/h 2.2 times 20.0 mmol/l

SF: 15–20% 1st to 2nd degree mitral valve insufficiency PDA ruled out

Initially 0.01 U/kg/h, increased to 0.03 U/kg/h 8 hours

NE: 3.0 μg/kg/minute E: 3.0 μg/kg/minute Enoximone: 5 μg/kg/minute

Despite AVP increased demand for catecholamines (NE/E: 5 μg/kg/minute)

Died after 8 hours of AVP therapy of cardio-respiratory failure; no ischemic lesions secondary to AVP therapy. A congenital cardiac malformation and cardiomyopathy were ruled out by autopsy

6

Twin I: 24 + 5 wks (F); caesarean delivery; 550 g APGAR: 1/5/7

RDS Bilateral pneumothoraces Second degree intracranial hemorrhage Mechanical ventilation Drainage of pneumothoraces

Non-septic circulatory collapse secondary to primary disease 6th day of life

0.3 ml/kg/h 2.7 times 10.9 mmol/l

SF: 32–34%

Initially 0.12 U/kg/h, increased to 0.36 U/kg/h 61 hours

NE: 0.4 μg/kg/minute E: 0.4 μg/kg/minute

Despite AVP catecholamines (NE/E: 0.6–0.8 μg/kg/minute)

Died after 61 hours of AVP medication; liver tissue necrosis seen on autopsy as a possible sequelae of AVP medication

  1. AVP, arginine-vasopressin; BPD: Bronchopulmonary dysplasia; E, epinephrine; F, female; HFOV, high frequency oscillatory ventilation; M, male; NE, norepinephrine; PDA, persistant ductus arteriosus; PIE, pulmonary interstitial emphysema; RDS, respiratory distress syndrome; ROP, retinopathy of prematurity; SF, shortening fraction.