Methylene Blue for Refractory Shock in A Neonate

Neonatal shock has a high mortality rate in neonates. New treatment approaches are being researched. Methylene blue (MB) may have the ability to enhance blood pressure but is rarely used on newborns. MB usage in a newborn with catecholamine-resistant shock who needed renal replacement therapy (RRT) due to hyperammonemia from an underlying urea cycle defect is presented here. A 3050-g female neonate, born at 38 weeks' gestation, was admitted to our neonatal intensive care unit on the fourth postnatal day due to hyperammonemia and encephalopathy. She was in shock but did not have sepsis, and her cardiological evaluation was normal. Upon detection of severe hyperammonemia, protein intake was ceased and ammonia-reducing medications were initiated. She required RRT due to persistent severe hyperammonemia, but despite receiving fluid resuscitation, vasopressors, and hydrocortisone, her blood pressure remained low until starting MB. Afterwards, RRT waseffectively performed. After continuous RRT, the patient's ammonia level decreased. Unfortunately, the patient died on the tenth day following delivery due to multiple organ failure. Catecholamine-resistant shock is a significant factor in neonatal mortality. In neonates with decompensated catecholamine-resistant shock and normal cardiac function, MB might be a novel therapeutic alternative. However, more studies are required to examine the efficacy, dose, and use.