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TOPLINE:

Many paediatric ICU (PICU) prescribers lacked knowledge about norepinephrine (NE) formulations they prescribed, creating risks in paediatric hypotensive shock.

METHODOLOGY:

• Researchers conducted a cross-sectional electronic survey from November 2023 to February 2024 via global paediatric critical care networks to characterise NE prescribing patterns in paediatric hypotensive shock, identify variations in dose reporting units, and assess knowledge gaps.
• The analysis included 424 complete responses (78.4% completion rate) from healthcare professionals, predominantly attending paediatric intensivists (81.4%).
• The 28-item survey gathered data on respondent demographics and NE prescribing, compounding, and administration practices.
• Respondents were classified into four geographical groups (Europe, America, Asia and Middle East, and Oceania) for comparison. Regional comparisons focused on differences in dosing units (NE base vs conjugated salt), initial doses, and thresholds prompting escalation to second-line therapies in hypotensive septic shock.
• The primary endpoint was the assessment of variability in NE dose reporting units; secondary endpoints were knowledge gaps and discrepancies in medication safety, compounding, and administration practices.

TAKEAWAY:

• Nearly half (43.9%) of PICU prescribers were unaware of the NE formulation, and 36.1% were uncertain whether dosing units referred to NE base or conjugated salt.
• American and Asian/Middle Eastern respondents initiated NE infusions at half the median dose used by European prescribers (0.05 vs 0.1 mcg/kg/min; P < .001).
• For hypotensive septic shock, American and Asian/Middle Eastern respondents tended to add second-line vasopressors at significantly lower NE doses than Europeans (median, 0.15 and 0.2 vs 0.5 mcg/kg/min; P < .0001).
• In 29.7% of PICUs, NE dose reporting lacked consensus on base vs conjugated salt, highlighting a critical standardisation gap.

IN PRACTICE:

"Clinicians should use norepinephrine base as their standard unit for norepinephrine dose reporting," the authors wrote.

SOURCE:

This study was led by Isabelle Goyer, Department of Pharmacy, CHU de Caen, Caen, France. It was published online on June 05, 2025, in the European Journal of Pediatrics.

LIMITATIONS:

The self-reported nature of the survey could have introduced bias and a potential for selection bias towards clinicians with a greater interest in the topic. Low response rates in certain regions, particularly non–French-speaking European and low-income countries, limited generalisability. Additionally, most respondents were physicians, with limited representation from pharmacists and nurses.

DISCLOSURES:

Two authors reported receiving funding from Braun Medical. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.