In pediatric septic shock refractory to initial fluid resuscitation with 60 mL/kg isotonic crystalloid, which vasoactive agent is recommended as first-line according to Surviving Sepsis Campaign pediatric guidelines?

• A Dopamine
• B Vasopressin
• C Milrinone
• D Norepinephrine for warm shock / Epinephrine for cold shock ✓

Explanation

The 2020 Surviving Sepsis Campaign pediatric guidelines recommend norepinephrine as first-line for warm (vasodilatory) shock and epinephrine as first-line for cold (low-output) shock. Dopamine, previously recommended, is associated with higher mortality and more arrhythmias in children and is no longer first-line. Vasopressin is used as adjunct for catecholamine-refractory vasodilatory shock. Milrinone is reserved for low cardiac output states, particularly post-cardiac surgery.

Reference: Ghai Essential Pediatrics, 10th ed.

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