From the Guidelines
Nipride (sodium nitroprusside) should be avoided in premature infants and neonates due to its association with necrotizing enterocolitis (NEC). When treating hypertension in neonates, alternative medications like hydralazine, labetalol, or nicardipine are preferred. If Nipride must be used in critical situations, it should be administered at the lowest effective dose (0.3-0.5 mcg/kg/min initially, not exceeding 2 mcg/kg/min) for the shortest possible duration (less than 72 hours) with continuous monitoring for signs of NEC and thiocyanate toxicity 1.
Key Considerations
- Nipride causes vasodilation by releasing nitric oxide, which can potentially lead to intestinal ischemia-reperfusion injury in the immature gut of neonates.
- The thiocyanate metabolite can accumulate in neonates due to their immature hepatic and renal systems, potentially causing toxicity.
- Regular monitoring of blood pressure, abdominal distension, bloody stools, and thiocyanate levels is essential if this medication must be used in neonatal patients.
- According to the most recent guidelines, probiotics such as Lactobacillus spp and Bifidobacterium spp can be used to prevent NEC in preterm infants less than 37 weeks gestational age and low birth weight 1.
Prevention of NEC
- The use of certain probiotic strains or combinations, such as Lactobacillus spp and Bifidobacterium spp, can reduce the risk of NEC in preterm infants 1.
- Combinations of Lactobacillus spp and Bifidobacterium spp, B animalis subsp lactis, L reuteri, or L rhamnosus can reduce all-cause mortality and severe NEC in preterm infants 1.
From the Research
Nipride and NEC
- There is no direct mention of Nipride in the provided studies, which focus on antibiotic treatments and patient outcomes in Necrotizing Enterocolitis (NEC) 2, 3, 4, 5, 6.
- The studies discuss various antibiotic regimens, including ampicillin, gentamicin, and metronidazole, as well as the use of vancomycin and antipseudomonal agents in the treatment of NEC 2, 4.
- The research suggests that the choice of antibiotics, route of administration, and duration of treatment for NEC are not well established, and more research is needed to optimize antibiotic therapy for this condition 2, 3, 5.
- The pathogenesis of NEC is not fully understood, but it is believed to involve an altered intestinal barrier immune response to feeding and the developing microbiome, as well as potential contributions from the enteric nervous system 3, 6.
- There is no evidence to suggest a direct link between Nipride and NEC, and further research would be needed to investigate any potential relationship between the two 2, 3, 4, 5, 6.