Use of vasopressin in neonatal hypertrophic obstructive cardiomyopathy: case series

Objective To determine the effect of vasopressin on arterial blood pressure in infants with neonatal hypertrophic obstructive cardiomyopathy (HOCM). Study design Retrospective case study in Neonatal ICU involving six infants; five born to mothers with diabetes mellitus (mean gestational age 37.5 ± 0.9 weeks). Vasopressin infusion was started at a mean dose of 0.3 ± 0.2 mU/kg/min. Result Initiation of vasopressin was followed by improved mean ( p = 0.004), systolic ( p = 0.028), and diastolic ( p = 0.009) arterial pressure within 2 h. Heart rate ( p = 0.025) and oxygen requirement ( p = 0.021) also declined after initiation. Serum sodium declined initially and recovered by 72 h ( p = 0.017). Conclusion Although there is limited experience with vasopressin use in neonatal HOCM, our case series suggests it may be beneficial for improving systemic hypotension and stabilization of hemodynamics. The potential for hyponatremia is high, necessitating careful fluid/electrolyte management. A prospective randomized trial is necessary to confirm safety and efficacy of vasopressin treatment in neonatal HOCM.