From the Research
For a 4-week-old septic patient requiring pressor support, norepinephrine is the preferred first-line vasopressor, as it has been shown to have a statistically significant superiority over dopamine in terms of in-hospital or 28-day mortality 1.
Key Considerations
- Norepinephrine should be started at a dose of 0.05-1 mcg/kg/min and titrated based on response, monitoring heart rate, blood pressure, and perfusion.
- Fluid resuscitation with 10-20 ml/kg of normal saline should precede vasopressors, and antibiotics must be started immediately.
- Continuous cardiorespiratory monitoring is essential, with frequent assessment of perfusion via capillary refill, urine output, and mental status.
- Neonates have immature cardiovascular systems with limited cardiac contractile reserve, making them particularly sensitive to both hypovolemia and medication effects.
- Careful titration is necessary as these patients can deteriorate rapidly, and consultation with pediatric critical care specialists is strongly recommended.
Additional Guidance
- According to the most recent study 2, norepinephrine is the first-choice vasopressor in septic and vasodilatory shock, and interventions that decrease norepinephrine dose have not decreased 28-day mortality significantly.
- In patients not responsive to norepinephrine, vasopressin or epinephrine may be added, and angiotensin II may be useful for rapid resuscitation of profoundly hypotensive patients.
- The use of vasopressors should be guided by the principles of early and effective fluid resuscitation and vasopressor administration to maintain tissue perfusion in septic shock patients 3.