Effects of Inhaled Iloprost for the Management of Persistent Pulmonary Hypertension of the Newborn

2021 ◽  
Author(s):  
Sourabh Verma ◽  
Rishi Lumba ◽  
Sadaf H. Kazmi ◽  
Michelle J. Vaz ◽  
Shrawani Soorneela Prakash ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Extracorporeal Membrane Oxygenation ◽  
Airway Pressure ◽  
Oxygenation Index ◽  
Retrospective Chart Review ◽  
Persistent Pulmonary Hypertension ◽  
Mean Airway Pressure ◽  
Membrane Oxygenation ◽  
Inhaled Iloprost ◽  
Oxygenation Indices

Objective The study aimed to evaluate the effects of inhaled iloprost on oxygenation indices in neonates with persistent pulmonary hypertension of the newborn (PPHN). Study Design We conducted a retrospective chart review of 30 patients with PPHN from January 2014 to November 2018, who did not respond to inhaled nitric oxide (iNO) alone and received inhaled iloprost. Twenty-two patients met the inclusion criteria and eight patients were excluded from the study (complex cardiac disease and extreme prematurity). Patients were categorized as responders or nonresponders (patients who required extracorporeal membrane oxygenation or died). Oxygenation index, mean airway pressure (MAP), and arterial partial pressure of oxygen (PaO2) were recorded. Results Among a total of 22 patients who were included in the study, 10 were classified as nonresponders as they required either extracorporeal membrane oxygenation or died. Gestational age and gender did not differ between responders and nonresponders. The median PaO2 was lower (37 vs. 42 mm Hg; p < 0.05) and median MAP was higher (20 vs. 17 cm H2O; p < 0.02) in nonresponders compared with responders just prior to initiating iloprost. Iloprost responders had a significant increase in median PaO2 and decrease in median oxygenation index in the 24 hours after initiating treatment (p < 0.05), with no significant change in required mean airway pressure over that same period. There was no change in vasopressor use or clinically significant worsening of platelets count, liver, and kidney functions after initiating iloprost. Conclusion Inhaled iloprost is well tolerated and seems to have beneficial effects in improving oxygenation indices in neonates with PPHN who do not respond to iNO. There is a need of well-designed prospective trials to further ascertain the benefits of using inhaled iloprost as an adjunct treatment in neonates with PPHN who do not respond to iNO alone. Key Points

Inhaled Nitric Oxide Trials: "Vive la différence!"

PEDIATRICS ◽  
1996 ◽  
Vol 97 (3) ◽  
pp. 438-438
Author(s):  
DENNIS DAVIDSON
Keyword(s):  
Nitric Oxide ◽  
Clinical Trials ◽  
Pulmonary Hypertension ◽  
Optimal Design ◽  
Extracorporeal Membrane Oxygenation ◽  
Rescue Therapy ◽  
Underlying Disease ◽  
Inhaled Nitric Oxide ◽  
Persistent Pulmonary Hypertension ◽  
Membrane Oxygenation

The commentary by Drs Abman and Kinsella entitled "Inhaled Nitric Oxide for Persistent Pulmonary Hypertension of the Newborn: The Physiology Matters!" provides one important and valid viewpoint concerning the optimal design of clinical trials in this area of neonatology. The approach that they advocate involves individualized and meticulous care of persistent pulmonary hypertension of the newborn (PPHN) patients depending on their underlying disease, using whatever conventional or rescue therapy (before extracorporeal membrane oxygenation [ECMO] is needed to support the patient, while testing the efficacy of inhaled nitric oxide (I-NO).

Persistent Pulmonary Hypertension and ECMO

PEDIATRICS ◽  
1990 ◽  
Vol 86 (5) ◽  
pp. 809-810
Author(s):  
ELCHANAN BRUCKHEIMER ◽  
ARTHUR I. EIDELMAN
Keyword(s):  
Pulmonary Hypertension ◽  
Extracorporeal Membrane Oxygenation ◽  
Meconium Aspiration Syndrome ◽  
Persistent Pulmonary Hypertension ◽  
Major Category ◽  
Inclusion Criteria ◽  
Meconium Aspiration ◽  
Membrane Oxygenation ◽  
Respiratory Treatment ◽  
The Relationship

To the Editor.— We read with interest Dr Gross' letter1 concerning the relationship between inborn and outborn infants with persistent pulmonary hypertension and the relevance of "classical" extracorporeal membrane oxygenation (ECMO) inclusion criteria and outcome of therapy. We wholly agree with his observation that early skilled respiratory treatment of infants with persistent pulmonary hypertension to a large extent can obviate the need for ECMO, and we wish to report our experience. As has been noted, the major category of patients requiring ECMO are those with severe meconium aspiration syndrome.2

The Extracorporeal Membrane Oxygenation Debate

PEDIATRICS ◽  
1990 ◽  
Vol 85 (3) ◽  
pp. 381-382
Author(s):  
WILLIAM D. RHINE ◽  
ALLEN F. FISCHER ◽  
DAVID K. STEVENSON
Keyword(s):  
Pulmonary Hypertension ◽  
Extracorporeal Membrane Oxygenation ◽  
Retrospective Review ◽  
Patient Population ◽  
Recent Article ◽  
Neonatal Care ◽  
Persistent Pulmonary Hypertension ◽  
Historical Comparison ◽  
Membrane Oxygenation ◽  
Statistical Inferences

To the Editor.— We are concerned about the statistical inferences, assumptions for comparisons, and arguments of logic implicit in the recent article on survival of infants with persistent pulmonary hypertension with ECMO (extracorporeal membrane oxygenation).1 The authors did acknowledge the difficulties of retrospective review, especially over 8 years when obstetrical and neonatal care should be improving. However, other details not reported on their patient population and classification might yield important information for this historical comparison.

scholarly journals Hydrocortisone Improves Oxygenation Index and Systolic Blood Pressure in Term Infants With Persistent Pulmonary Hypertension

2019 ◽  
Vol 13 ◽  
pp. 117955651988891 ◽  
Author(s):  
Mahdi Alsaleem ◽  
Aysha Malik ◽  
Satyan Lakshminrusimha ◽  
Vasantha HS Kumar
Keyword(s):  
Blood Pressure ◽  
Pulmonary Hypertension ◽  
Systolic Blood Pressure ◽  
Animal Studies ◽  
Oxygenation Index ◽  
Retrospective Chart Review ◽  
Meconium Aspiration Syndrome ◽  
Persistent Pulmonary Hypertension ◽  
Term Infants ◽  
Near Term

Persistent pulmonary hypertension of the newborn (PPHN) is an essential cause for hypoxic respiratory failure with significant morbidity and mortality in term and near-term neonates. Hydrocortisone has been shown to decrease oxygen dependency and pulmonary hypertension in neonates with meconium aspiration syndrome and animal studies, respectively. We hypothesize that hydrocortisone will improve oxygenation in term and near-term infants with pulmonary hypertension. We performed a retrospective chart review of all infant with PPHN who received intravenous hydrocortisone therapy as a rescue for severe PPHN. Clinical response was objectively measured using, oxygenation index (OI), PaO2/FiO2 ratio, and inotrope score before, during, and after the hydrocortisone course. We found that hydrocortisone administration resulted in significant improvement of systolic blood pressure, OI, and PaO2/FiO2. In conclusion, hydrocortisone increased systolic blood pressure and improved oxygenation in term and near-term infants with persistent pulmonary hypertension. Prospective randomized trials are required to evaluate these findings further.

Severe Respiratory Failure After Elective Repeat Cesarean Delivery: A Potentially Preventable Condition Leading to Extracorporeal Membrane Oxygenation

PEDIATRICS ◽  
1992 ◽  
Vol 89 (4) ◽  
pp. 670-672
Author(s):  
MARTIN KESZLER ◽  
MARY TERESE CARBONE ◽  
CYNTHIA COX ◽  
ROBERT E. SCHUMACHER
Keyword(s):  
Pulmonary Hypertension ◽  
Extracorporeal Membrane Oxygenation ◽  
Cesarean Delivery ◽  
Premature Neonate ◽  
Persistent Pulmonary Hypertension ◽  
Respiratory Morbidity ◽  
Membrane Oxygenation ◽  
Elective Cesarean ◽  
Elective Repeat Cesarean ◽  
Repeat Cesarean Delivery

Significant respiratory morbidity following elective cesarean delivery has been widely reported.1-4 More recently, it has been recognized that this morbidity is not always the result of inadvertent delivery of a premature neonate,5 but, instead, may be due to a predilection of these neonates for developing persistent pulmonary hypertension of the newborn(PPHN).6-8 Despite Heritage and Cunningham's report6 of 25% mortality in patients with persistent pulmonary hypertension following elective repeat cesarean section, the potential severity of respiratory distress associated with this method of delivery does not appear to be generally recognized. Extracorporeal membrane oxygenation (ECMO) is increasingly used to treat newborns

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