RT Journal Article SR Electronic T1 O-7 Vasopressin and terlipressin for refractory shock in neonates and children: systematic review meta-analysis and trial sequential analysis JF Archives of Disease in Childhood JO Arch Dis Child FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health SP A3 OP A3 DO 10.1136/archdischild-2017-esdppp.7 VO 102 IS 10 A1 Reem A1 Reif A1 Matok A1 Amichai A1 Hirsh Raccah A1 Paret YR 2017 UL http://adc.bmj.com/content/102/10/A3.2.abstract AB Background Vasopressin (AVP) and terlipressin (TP) have been used as last line therapy in refractory shock in children. However, the efficacy and safety of AVP and TP were not determined these populations. We aimed to assess the efficacy and safety of AVP/TP in paediatric re-fractory shock.Methods We conducted a systematic review, meta-analysis, and trial sequential analysis (TSA). AVP and TP, were compared with conventional therapy. MEDLINE, EMBASE, Cochrane Library, and ClinicalTrials.gov were searched up to February 2016. Reports of clinical trials were pooled using random-effects models and TSA. Main outcomes were mortality and tissue ischemia.Results Three randomised control trials and five ‘be-fore-and-after clinical’ trials met the inclusion criteria. Among 224 neonates and children, with refractory shock, 152 received therapy with AVP or TP. Pooled analyses, showed no association between AVP/TP treatment and mortality (relative risk (RR),1.19; 95% CI, 0.71–2.00), length of stay in the paediatric intensive care department (PICU) (mean difference (MD), −3.58 days; 95% CI, (−9.05) −1.83) and events of tissue ischemia (RR, 1.48; 95% CI, 0.47–4.62). In TSA, no significant effect on mortality and developing tissue ischemia was observed with AVP/TP therapy.Conclusion AVP/TP therapy was not associated with a decreased risk for mortality and for length of stay in PICU. Furthermore, in TSA, a trend for an association with an increased risk for ischaemic events was observed. Our study suggests that further large studies are necessary to demonstrate and establish benefits of AVP/TP in children.PROSPERO registry-CRD42016035872