Clinical and Laboratory ObservationsInhaled prostacyclin for term infants with persistent pulmonary hypertension refractory to inhaled nitric oxide*,**
Section snippets
Patients
Four term infants with hypoxemic respiratory failure and PPHN were transferred to our Neonatal Intensive Care Unit (NICU) (Table).Characteristic Patient 1 Patient 2 Patient 3 Patient 4 Gestational age 40 wk 42 wk, 6 d 40 wk 39 wk Birth weight (kg) 3.4 4.1 3.6 3.5 Diagnoses MAS MAS MAS Sepsis Sepsis Sepsis Sepsis ACD Birth asphyxia Time interval from surfactant to initiation of
Methods
Inhaled PGI2 was delivered by aerosolizing the intravenous formulation (Flolan, Glaxo-Wellcome, Middlesex, UK), as previously reported.7 PGI2 was dissolved in 20 mL of manufacturer's diluent (a glycine buffer, pH 10) to deliver 50 ng/kg per minute. Fresh solution was added every 4 hours to a nebulization chamber attached to the respirator circuit. This study was approved by our institutional review board, and parental consent was obtained.
Discussion
The use of inhaled PGI2 in doses ranging from 20 to 100 ng/kg per minute has been shown to improve oxygenation and decrease pulmonary arterial pressure in neonates with pulmonary hypertension with no effect on systemic blood pressure.7, 8 However, inhaled NO was not used in these infants, either before or in conjunction with inhaled PGI2. All of the infants were hypoxemic despite the use of NO, prompting the consideration of inhaled PGI2 to augment pulmonary vasodilation.
Oxygenation improved in
References (8)
Inhaled nitric oxide in full-term and nearly full-term infants with hypoxic respiratory failure
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(1997)- et al.
Low dose nitric oxide therapy for persistent pulmonary hypertension of the newborn
N Engl J Med
(2000) - et al.
Prostacyclin in the treatment of neonatal pulmonary hypertension
J Pediatr
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An evaluation of nebulized prostacyclin in patients with primary and secondary pulmonary hypertension
Eur Heart J
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Cited by (0)
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Dr Steinhorn is a member of the INO Therapeutics Advisory Panel.
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Reprint requests: Robin H. Steinhorn, MD, Neonatology #45, The Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614.