Norepinephrine Pediatric Dose — Vasopressor Infusion
Norepinephrine is a catecholamine vasopressor that acts primarily on α1-adrenergic receptors to produce potent vasoconstriction, with additional β1-adrenergic activity that supports cardiac contractility. It is a first-line agent for distributive shock — most commonly septic shock — in the pediatric population. In PICU and emergency settings, it is used to restore adequate systemic vascular resistance and mean arterial pressure when fluid resuscitation alone is insufficient.
Pediatric Dosing
Norepinephrine is administered as a continuous intravenous infusion, titrated to clinical and hemodynamic effect:
- Dose range: 0.05 mcg/kg/min – 2 mcg/kg/min IV/IO continuous infusion
- Begin at the lower end of the range and titrate upward based on blood pressure and perfusion targets.
Worked example — 20 kg child:
Starting dose: 20 kg × 0.05 mcg/kg/min = 1 mcg/min
Maximum dose: 20 kg × 2 mcg/kg/min = 40 mcg/min
Consult institutional protocol for specific concentration preparation, infusion pump programming, and upper titration limits, as practice may vary by center.
Indications and Clinical Context
Norepinephrine is indicated for vasodilatory (distributive) shock, including septic shock, when mean arterial pressure remains inadequate despite appropriate fluid resuscitation. Surviving Sepsis Campaign guidelines and PALS support early vasoactive agent use in fluid-refractory pediatric septic shock. Its predominant α-adrenergic activity makes it particularly well-suited for states of pathologically low systemic vascular resistance. It may also be used as a second-line or adjunct agent in other shock states under specialist guidance.
Hemodynamic goals should be defined prior to initiation — typically targeting age-appropriate mean arterial pressure and clinical markers of adequate end-organ perfusion (capillary refill, urine output, mental status).
Administration and Monitoring
Norepinephrine should preferably be administered via a central venous catheter due to the risk of tissue necrosis from extravasation; however, short-term peripheral or intraosseous administration may be acceptable in emergent situations until central access is secured. It is delivered as a continuous infusion — never as an IV bolus. Concentration and infusion rate should be verified according to institutional pharmacy protocols and weight-based infusion guidelines.
- Route: Central venous access preferred; peripheral IV or IO acceptable short-term in emergencies
- Adverse effects to monitor: Hypertension, reflex bradycardia, peripheral vasoconstriction, digital/limb ischemia, arrhythmias
- Extravasation precaution: Monitor infusion site closely; phentolamine infiltration may be used for extravasation injury
- Contraindications: Hypovolemia not yet corrected; use with caution in hypertensive states
- Continuous hemodynamic monitoring (arterial line preferred) is strongly recommended during infusion
Disclaimer: This article is an educational reference summarizing standard pediatric dosing values. It is not a substitute for clinical judgment. Always verify doses against institutional protocols, the current edition of authoritative references (e.g., Lexicomp, Harriet Lane Handbook, PALS guidelines), the patient’s accurate weight, and any patient-specific factors (renal/hepatic function, allergies, comedications) before administration.