Elsevier

The Journal of Pediatrics

Volume 141, Issue 6, December 2002, Pages 830-832
The Journal of Pediatrics

Clinical and Laboratory Observations
Inhaled prostacyclin for term infants with persistent pulmonary hypertension refractory to inhaled nitric oxide*,**

https://doi.org/10.1067/mpd.2002.129849Get rights and content

Abstract

We report the use of inhaled prostacyclin (PGI2) in 4 neonates with persistent pulmonary hypertension and hypoxemia refractory to inhaled nitric oxide. Oxygenation rapidly improved after inhalation of PGI2 in all infants. The condition of one infant subsequently deteriorated, and alveolar capillary dysplasia was found at autopsy. The surviving infants were discharged with normal oxygen saturations in room air. (J Pediatr 2002;141:830-32)

Section snippets

Patients

Four term infants with hypoxemic respiratory failure and PPHN were transferred to our Neonatal Intensive Care Unit (NICU) (Table).

Table. Characteristics of 4 patients with persistent pulmonary hypertension of the newborn refractory to therapy with inhaled nitric oxide

CharacteristicPatient 1Patient 2Patient 3Patient 4
Gestational age40 wk42 wk, 6 d40 wk39 wk
Birth weight (kg)3.44.13.63.5
DiagnosesMASMASMASSepsis
SepsisSepsisSepsisACD
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

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Cited by (0)

*

Dr Steinhorn is a member of the INO Therapeutics Advisory Panel.

**

Reprint requests: Robin H. Steinhorn, MD, Neonatology #45, The Children's Memorial Hospital, 2300 Children's Plaza, Chicago, IL 60614.

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