Title:Methylene Blue not Contraindicated in Treating Hemodynamic Instability in Pediatric and Neonate Patients
Volume: 18
Issue: 1
Author(s): Walusa A. Gonçalves-Ferri, Agnes A.S. Albuquerque, Patricia Martinez Evora and Paulo R.B. Evora*
Affiliation:
- Department of
Surgery and Anatomy, Ribeirão Preto Medical School-University of São Paulo, São Paulo, Brazil
Keywords:
Circulatory shock, vasoplegia, methylene blue, nitric oxide, mean arterial pressure (MAP), hemodynamic instability.
Abstract: The present review was carried out to describe publications on the use of methylene
blue (MB) in pediatrics and neonatology, discussing dose, infusion rate, action characteristics, and
possible benefits for a pediatric patient group. The research was performed on the data sources
PubMed, BioMed Central, and Embase (updated on Aug 31, 2020) by two independent investigators.
The selected articles included human studies that evaluated MB use in pediatric or neonatal patients
with vasoplegia due to any cause, regardless of the applied methodology. The MB use and 0
to 18-years-old patients with vasodilatory shock were the adopted criteria. Exclusion criteria were
the use of MB in patients without vasoplegia and patients ≥ 18-years-old. The primary endpoint
was the increase in mean arterial pressure (MAP). Side effects and dose were also evaluated.
Eleven studies were found, of which 10 were case reports, and 1 was a randomized clinical study.
Only two of these studies were with neonatal patients (less than 28 days-old), reporting a small
number of cases (1 and 6). All studies described the positive action of MB on MAP, allowing the
decrease of vasoactive amines in several of them. No severe side effects or death related to the use
of the medication were reported. The maximum dose used was 2 mg/kg, but there was no consensus
on the infusion rate and drug administration timing. Finally, no theoretical or experimental basis
sustains the decision to avoid MB in children claiming it can cause pulmonary hypertension.
The same goes for the concern of a possible deleterious effect on inflammatory distress syndrome.
