Effect of methylene blue on refractory neonatal hypotension

J Pediatr. 1996 Dec;129(6):904-8. doi: 10.1016/s0022-3476(96)70036-7.


Excess nitric oxide is a mediator of the hypotension in septic shock. Nitric oxide dilates vascular smooth muscle through activation of soluble guanylate cyclase. We report the increase in blood pressure caused by methylene blue (MB), a soluble guanylate cyclase inhibitor, in five neonates with presumed septic shock unresponsive to colloids, inotropic agents, and corticosteroids. MB was given intravenously at a dose of 1 mg/kg during a 1-hour period. MB increased blood pressure in each patient (average, 33% +/- 20%). Blood pressure subsequently decreased to near baseline values in three patients, who then received a second infusion of MB. Blood pressure again increased in these patients. Three of five patients were weaned from inotropic support within 72 hours. Three of five patients survived and were discharged home. We suggest that MB increased blood pressure in these neonates with refractory hypotension.

Publication types

  • Case Reports
  • Comparative Study

MeSH terms

  • Blood Pressure / drug effects
  • Diseases in Twins
  • Drug Evaluation
  • Female
  • Heart Rate / drug effects
  • Humans
  • Hypotension / blood
  • Hypotension / drug therapy*
  • Hypotension / physiopathology
  • Infant, Newborn
  • Infant, Premature
  • Infusions, Intravenous
  • Male
  • Methylene Blue / administration & dosage*
  • Nitric Oxide / antagonists & inhibitors
  • Shock, Septic / blood
  • Shock, Septic / drug therapy
  • Shock, Septic / physiopathology


  • Nitric Oxide
  • Methylene Blue