Norepinephrine Shows Promise in Pediatric Septic Shock Management

The full authorship of the original study carried out by Dr. Matthew A. Eisenberg, Division of Emergency Medicine, Boston Children’s Hospital. This research provides important, new, real-world evidence of the effectiveness of vasoactive medications for treating pediatric septic shock. The study was designed as a retrospective cohort study. It looked at 231 total patient visits and specifically looked at the outcome of children treated with epinephrine vs. norepinephrine.

The research, which appeared online April 11, 2025, in JAMA Network Open, included study participants with a median age of 11.4 at enrollment. Of those participants, 54.6% were female. The study’s objective was to determine the best possible primary outcome, which they named MAKE30. This composite metric incorporates important occurrences including mortality, new KRT, or enduring kidney injury at 30 days or at the time of hospital discharge.

Study Findings and Patient Outcomes

Interestingly, in our study, 63.6% of the patients received epinephrine as their first vasoactive medication. Only 36.4% were the recipients of norepinephrine. The findings showed significant, clear differences in mortality between the two populations. In particular, the 30-day mortality of patients treated with epinephrine was 3.7%. Patients treated with norepinephrine had a remarkable 0% mortality rate over this same time period.

Beyond access, the study observed significant disparities in mortality rates among the groups. Once IPW was accounted for, there were no significant differences in achieving the MAKE30 outcome between treatment groups. This serves to underscore a critical consideration for clinicians. They should use caution when selecting the first vasoactive agent for the treatment of septic shock in children.

Implications for Clinical Practice

Dr. Eisenberg stressed the importance of these findings for pediatric septic shock healthcare delivery. He stated,

“These findings suggest that children without known cardiac dysfunction who received norepinephrine as the initial vasoactive agent for septic shock had lower mortality but similar rates of MAKE30 compared with children receiving epinephrine.”

This insight may encourage healthcare providers to reassess their treatment protocols and consider norepinephrine as a first-line medication in similar patient scenarios.