Vasopressin for hemodynamic support in neonates: current evidence and clinical applications

To systematically map and synthesize the available evidence on the use of vasopressin for hemodynamic support in neonates. We conducted a scoping review to synthesize available data on indications, dosing, clinical effects, and safety. Twelve studies were included (one randomized trial, eleven observational), encompassing heterogeneous neonatal populations. Vasopressin was primarily used as rescue therapy in refractory shock, including sepsis, persistent pulmonary hypertension of the newborn, and congenital diaphragmatic hernia. Dosing regimens varied widely. Most studies reported improvements in mean arterial blood pressure, with some demonstrating reduced vasoactive support and improved oxygenation. Effects on urine output were variable. Safety reporting was inconsistent; hyponatremia was the most commonly described adverse event, while serious ischemic complications were rarely reported. Vasopressin may improve short-term hemodynamic parameters, but evidence is limited and heterogeneous, with insufficient data to guide optimal use.