JAMA Netw Open

Norepinephrine shows survival benefit over epinephrine in pediatric septic shock

April 16, 2025

Study details: This single-center, retrospective cohort study examined the outcomes of 231 children aged 1 month to 18 years with septic shock who received either epinephrine (n=147) or norepinephrine (n=84) as the first vasoactive medication within 24 hours of emergency department arrival. The study utilized propensity score matching to analyze data from 2017 to 2023, focusing on major adverse kidney events by 30 days (MAKE30) and other secondary outcomes such as mortality and need for mechanical ventilation.

Results: In the epinephrine group, 6.1% met MAKE30 and 4.1% died within 30 days. In the norepinephrine group, 3.6% met MAKE30 with no deaths. However, after inverse probability of treatment weighting, no significant difference in MAKE30 was found between the two groups. With propensity matching, epinephrine was associated with greater 30-day mortality compared with norepinephrine (risk difference: 3.7%; 95% confidence interval [CI] 0.2%-7.2%).

Clinical impact: Norepinephrine may be preferable as the initial vasoactive agent in pediatric septic shock due to its association with lower 30-day mortality. Authors call for prospective, confirmatory studies to determine if norepinephrine should be the first-line vasoactive agent in pediatric septic shock.

Source:

Eisenberg MA, et al. (2025, April 1). JAMA Netw Open. Epinephrine vs Norepinephrine as Initial Treatment in Children With Septic Shock. https://pubmed.ncbi.nlm.nih.gov/40214988/