Improvement of Serum Ferritin Levels With Inotropic Administration in Early Phase Compared to Refractory Phase in Pediatric Patients With Septic Shock: A Preliminary Randomized Controlled Trial Study

Background: Septic shock, particularly protracted or refractory shock episodes, is a significant cause of morbidity and mortality in the pediatric critical care unit. According to current guidelines, only refractory cases have received inotrope administration in the therapy of septic shock; however, there haven't been many investigations to determine whether earlier administration could improve outcomes. Methods: : This randomized controlled trial compared the effects of giving epinephrine immediately after resuscitation to giving it an hour later. The surrogate endpoint of morbidity was measured by several laboratory parameters, including peripheral oxygen saturation, leukocyte count, c-reactive protein (CRP), ferritin, troponin I, and serum lactate levels. These parameters were measured at 1, 6, and 24 hours following admission. Results: : A total of 26 patients with a mean Pediatric Logistic Organ Dysfunction (PELOD) score of 8.43.0 were included in the analysis. In comparison to the refractory phase, the early phase administration of inotropic resulted in reduced leukocyte count, CRP, and serum ferritin levels at 1st and 24th hours, as well as lower serum lactate levels at 6th and 24th hours. Serum ferritin levels were considerably lower at the first hour following initial inotropic delivery, with a mean difference of 1271.1 ng/mL (p = 0.026). Conclusion: The ferritin levels at the first hour showed that inotropic administration during the first phase provided superior results than inotropic administration during the refractory phase. To analyze the results more comprehensively, further larger scale prospective investigations are required.