Terlipressin as rescue therapy for intractable hypotension during neonatal septic shock

To report the successful use of terlipressin in an 8-day-old infant for treatment of intractable hypotension caused by septic shock. Descriptive case report. An 18-bed pediatric intensive care unit at a tertiary care children's hospital. An 8-day-old child with intractable hypotension due to septic shock after heart surgery. General supportive intensive care including mechanical ventilatory support, volume replacement, and inotropic support with dopamine 20 microg.kg(-1).min(-1), milrinone 0.75 microg.kg(-1).min(-1), and epinephrine 0.8 microg.kg(-1).min(-1). Terlipressin (7 microg/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. 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.