Septic shock remains a leading cause of pediatric mortality, but the choice of first-line vasoactive agent has long been debated. Dr Newton, a PGY-3, discusses this single-center retrospective cohort study comparing epinephrine and norepinephrine as initial infusions in children with septic shock. While the primary kidney outcome (MAKE30) showed no difference, epinephrine was linked to higher 30-day mortality in propensity-matched analysis. The findings are hypothesis-generating and highlight the need for prospective pediatric trials.

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