Blood pressure rose after vasopressin; benefit remains unproved

In 87 extremely preterm infants receiving rescue vasopressin, median mean blood pressure rose from 29 to 39 mmHg by 24 hours. With no comparator, shrinking follow-up and 60 deaths before discharge, the study describes physiologic response—not treatment benefit.

THE HOT TAKE

A better number on the monitor is a physiologic observation—not evidence that rescue vasopressin improved survival.

Alamer and colleagues reviewed 87 infants born before 29 weeks who received vasopressin for refractory cardiopulmonary instability in one Riyadh NICU from 2017 through 2025. Median gestation was 25 weeks and birth weight 650 g. The record listed a median of four vasoactive inotropes before vasopressin initiation. This was clinician-selected rescue therapy, not a randomized comparison.

Most starts were for oxygenation failure (61/87, 70.1%); another 19/87 had combined hypotension and oxygenation failure, and only 7/87 had hypotension alone. That mixed rescue phenotype matters: this is not simply a study of isolated low blood pressure.

WHAT CHANGED—AND WHAT THAT MEANS