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 μg·kg ^-1·min^-1, milrinone 0.75 μg·kg ^-1·min^-1, and epinephrine 0.8 μg·kg ^-1·min^-1. Measurements and Main Results: Terlipressin (7 μg/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.