Efficacy and safety of vasopressin and terlipressin in preterm neonates: a protocol for a systematic review

Abstract

BackgroundThe use of vasoactive agents like arginine vasopressin (AVP) and terlipressin to treat hypotension or persistent pulmonary hypertension in critically ill preterm neonates is increasing. Therefore, a systematic review of the available data on dosing, efficacy and safety of AVP and terlipressin in this patient population appears beneficial.MethodsWe will conduct a systematic review of the available evidence on the use of AVP and terlipressin for the treatment of hypotension or persistent pulmonary hypertension in preterm neonates. We will search Ovid MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science and Google Scholar from inception to March 2021. Two reviewers will independently screen titles and abstracts, review the full text of eligible studies, extract data, assess the risk of bias and judge the certainty of the evidence. Our primary outcome will be an (1) improvement of end-organ perfusion after initiation of AVP or terlipressin and (2) mortality prior to discharge. Our secondary outcomes will include (1) major neurosensory abnormality and (2) the occurrence of adverse events.DiscussionThe currently available evidence on the efficacy and safety of AVP and terlipressin in preterm neonates is limited. Yet, evidence on the pharmacology of these drugs and the pathophysiology of vasoplegic shock support the biological plausibility for their clinical effectiveness in this population. Therefore, we aim to address this gap concerning the use of vasopressin and terlipressin among critically ill preterm neonates.Trial registrationThis protocol has been submitted for registration to the international database of prospectively registered systematic reviews (PROSPERO, awaiting registration number).

Efficacy and Safety of Vasopressin and Terlipressin in Preterm Neonates: A Systematic Review

“…The reporting of this systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist [ 21 ]. The protocol for this review was prospectively registered (PROSPERO, registration number CRD42021236094) and published [ 22 ]. Box 1 provides the Population, Intervention, Control, Outcome (PICO) framework used for this review.…”

“…The Tool for Evaluating the Methodological Quality of Case Reports and Case Series [ 24 ], the adapted Retrospectoscope for Reducing Bias in Chart Review Studies [ 25 ] and the Cochrane Collaboration Risk of Bias 2.0 tool [ 26 ] were used, as appropriate. The scales that we proposed in our original protocol [ 22 ] were not applicable to the included studies, thus, we modified the scales for our risk of bias assessment based on applicability.…”

Synthetic Peptides in Doping Control: A Powerful Tool for an Analytical Challenge

“…Also, vasopressin activates V2, V1b, and oxytocin receptors, which explains its antidiuretic and procoagulant activity. 47,48 Other diuretics relevant to the study of antidoping substances are felypressin (phenylalanine-lys-vasopressin), terlipressin (trigly-8-lys-vasopressin), and lypressin (8-lysvasopressin), which have been included in screening studies to detect peptide hormones in human urine. 49 It is important to point out that WADA states that local administration of felypressin in connection with local anesthesia during a dental treatment is not prohibited.…”

“…Vasopressin is synthesized in the hypothalamus and has the property of increasing blood pressure through vasoconstriction (due to activation of V1a receptors). Also, vasopressin activates V2, V1b, and oxytocin receptors, which explains its antidiuretic and procoagulant activity. , …”

“…Also, vasopressin activates V2, V1b, and oxytocin receptors, which explains its antidiuretic and procoagulant activity. 47 , 48 …”