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BMC Pediatrics
Published in: BMC Pediatrics 1/2019

Open Access 01-12-2019 | Heart Surgery | Research article

First experience with Tolvaptan for the treatment of neonates and infants with capillary leak syndrome after cardiac surgery

Authors: Anne Kerling, Okan Toka, André Rüffer, Hanna Müller, Sheeraz Habash, Christel Weiss, Sven Dittrich, Julia Moosmann

Published in: BMC Pediatrics | Issue 1/2019

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Abstract

Background

Postoperative fluid management in critically ill neonates and infants with capillary leak syndrome (CLS) and extensive volume overload after cardiac surgery on cardiopulmonary bypass is challenging. CLS is often resistant to conventional diuretic therapy, aggravating the course of weaning from invasive ventilation, increasing length of stay on ICU and morbidity and mortality.

Methods

Tolvaptan (TLV, vasopressin type 2 receptor antagonist) was used as an additive diuretic in neonates and infants with CLS after cardiac surgery. Retrospective analysis of 25 patients with CLS including preoperative and postoperative parameters was performed. Multivariate regression analysis was performed to identify predictors for TLV response.

Results

Multivariate analysis identified urinary output during 24 h after TLV administration and mean blood pressure (BP) on day 2 of TLV treatment as predictors for TLV response (AUC = 0.956). Responder showed greater weight reduction (p < 0.0001), earlier weaning from ventilator during TLV (p = 0.0421) and shorter time in the ICU after TLV treatment (p = 0.0155). Serum sodium and serum osmolality increased significantly over time in all patients treated with TLV.

Conclusion

In neonates and infants with diuretic-refractory CLS after cardiac surgery, additional aquaretic therapy with TLV showed an increase in urinary output and reduction in bodyweight in patients classified as TLV responder. Increase in urinary output and mean BP on day 2 of treatment were strong predictors for TLV response.
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Metadata
Title
First experience with Tolvaptan for the treatment of neonates and infants with capillary leak syndrome after cardiac surgery
Authors
Anne Kerling
Okan Toka
André Rüffer
Hanna Müller
Sheeraz Habash
Christel Weiss
Sven Dittrich
Julia Moosmann
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2019
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-019-1418-6

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