scholarly journals Efficacy of a combination of sildenafil and magnesium sulfate in the treatment of persistent pulmonary hypertension of the newborn, and its influence on hemodynamics

2021 ◽  
Vol 20 (10) ◽  
pp. 2163-2169
Author(s):  
Shuping Huang ◽  
Tao Zhong
Keyword(s):  
Pulmonary Hypertension ◽  
Magnesium Sulfate ◽  
Vascular Resistance ◽  
Post Treatment ◽  
Persistent Pulmonary Hypertension ◽  
Inflammatory Factors ◽  
Enzyme Linked Immunosorbent Assay ◽  
Respiratory Parameters ◽  
Combined Use ◽  
Hospitalization Period

Purpose: To investigate the efficacy of the combined use of sildenafil and magnesium sulfate in the treatment of persistent pulmonary hypertension of the newborn (PPHN), and its influence on hemodynamics.Methods: A total of 174 children with persistent pulmonary hypertension who were treated in Ganzhou People’s Hospital, Ganzhou, China were selected and randomly assigned to joint group (JG) and control group (CG), with 87 patients in each group. The CG group received magnesium sulfate, while the JG group received sildenafil plus magnesium sulphate. The respiratory parameters of the children were analyzed using blood gas analyzer, while their hemodynamic indices were evaluated using color Doppler echocardiography. The levels of cytokines and inflammatory factors were determined by enzyme-linked immunosorbent assay (ELISA).Results: Time taken for symptom disappearance, oxygen therapy, and hospitalization period were shorter in JG than in CG (p < 0.05). Post-treatment, the respiratory parameters (PaO2, PaCO2, and SaO2) in both groups s improved, with lower levels of PaO2 and PaCO2, and a higher level of SaO2 in JG (p < 0.05). Following treatment, the levels of systemic vascular resistance (SVR), posterior pulmonary vascular resistance (PVR) and pulmonary artery pressure (PA) in JG were significantly reduced, relative to CG (p < 0.05). Similarly, the expression of endothelin -1 (ET-1), brain natriureticpeptide (BNP), and angiotensin 1 (ANG-1) improved, with lower levels of ET-1 and BNP, and a higher level of ANG-1 in JG (p < 0.05). There was post-treatment reduction as well in IL-6 and TNF-α, with lower levels in JG (p < 0.05). Patients in JG showed higher total treatment effectiveness and a lowerincidence of adverse reactions than those in CG (p < 0.05).Conclusion: The combined use of sildenafil and magnesium sulfate enhances the management of PPHN, ameliorates respiratory parameters, hemodynamics, and levels of cytokines and inflammatory factors. These findings provide evidence-based medical references for a new treatment strategy for PPHN.

scholarly journals Inhaled Nitric Oxide at Birth Reduces Pulmonary Vascular Resistance and Improves Oxygenation in Preterm Lambs

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 378
Author(s):  
Satyan Lakshminrusimha ◽  
Sylvia F. Gugino ◽  
Krishnamurthy Sekar ◽  
Stephen Wedgwood ◽  
Carmon Koenigsknecht ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Pulmonary Hypertension ◽  
Pulmonary Vascular Resistance ◽  
Preterm Infants ◽  
Vascular Resistance ◽  
Inhaled Nitric Oxide ◽  
Persistent Pulmonary Hypertension ◽  
Inhaled No ◽  
Birth Preterm

Resuscitation with 21% O2 may not achieve target oxygenation in preterm infants and in neonates with persistent pulmonary hypertension of the newborn (PPHN). Inhaled nitric oxide (iNO) at birth can reduce pulmonary vascular resistance (PVR) and improve PaO2. We studied the effect of iNO on oxygenation and changes in PVR in preterm lambs with and without PPHN during resuscitation and stabilization at birth. Preterm lambs with and without PPHN (induced by antenatal ductal ligation) were delivered at 134 d gestation (term is 147–150 d). Lambs without PPHN were ventilated with 21% O2, titrated O2 to maintain target oxygenation or 21% O2 + iNO (20 ppm) at birth for 30 min. Preterm lambs with PPHN were ventilated with 50% O2, titrated O2 or 50% O2 + iNO. Resuscitation with 21% O2 in preterm lambs and 50%O2 in PPHN lambs did not achieve target oxygenation. Inhaled NO significantly decreased PVR in all lambs and increased PaO2 in preterm lambs ventilated with 21% O2 similar to that achieved by titrated O2 (41 ± 9% at 30 min). Inhaled NO increased PaO2 to 45 ± 13, 45 ± 20 and 76 ± 11 mmHg with 50% O2, titrated O2 up to 100% and 50% O2 + iNO, respectively, in PPHN lambs. We concluded that iNO at birth reduces PVR and FiO2 required to achieve target PaO2.

scholarly journals Use of Magnesium Sulphate in Persistent Pulmonary Hypertension of Newborn

2020 ◽  
Vol 10 (2) ◽  
pp. 370-372
Author(s):  
Mohammad Abdullah Al Mamun ◽  
Sheuly Begum ◽  
Manzoor Hussain ◽  
Dr Abdul Jabbar
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Vascular Resistance ◽  
Vascular Resistance ◽  
Magnesium Sulphate ◽  
Born Term ◽  
Persistent Pulmonary Hypertension ◽  
Term Infants ◽  
Medical College ◽  
Common Causes ◽  
Study Population

Background: One of the common causes of respiratory distress in neonate is persistent pulmonary hypertension of newborn (PPHN) and has been estimated to occur in 2 per 1000 live born term infants. Objective: To evaluate the effect of injectable Magnesium Sulphate (MgSO4) in the treatment of Persistent Pulmonary Hypertension of Newborn. Methodology: It was a prospective, nonrandomized, clinical study conducted from August 2015 to July 2017 among 25 neonates having moderate to severe PPHN in the Pediatric Cardiac Intensive Care Unit (CICU) of Dhaka Shishu (Children) Hospital. Injectable Magnesium Sulphate was used along with other supportive management. Outcome measures include drop of pulmonary vascular resistance and increase oxygenation. Side effects of Magnesium Sulphate were observed and outcome was recorded. Data were analyzed by using SPSS version 17. Results: There was significant improvement of oxygenation and decrease in pulmonary vascular resistance at 72 hours after use of MgSO4 (p=000). Complications were present in 28% cases which include hypotension in 16% patients, urinary retention in 8% and altered GI function in 8% cases. Mortality was 16% among study population. Conclusion: MgSO4 is effective in improving oxygenation and reduction of pulmonary vascular resistance in PPHN Northern International Medical College Journal Vol.10 (2) Jan 2019: 370-372

The Role of Magnesium Sulfate in the Treatment of Persistent Pulmonary Hypertension in the Neonate : Our Experience in King Hussein Medical Centre (KHMC)

2020 ◽  
Vol 27 (2) ◽  
pp. 21-26
Author(s):  
Ayash , Fadi Farhan ◽  
Saleh , Alaeddin Ali ◽  
Alyassen , Abdalrazzaq Ahmad ◽  
Alhadidi , Aghadir Mohammad
Keyword(s):  
Pulmonary Hypertension ◽  
Magnesium Sulfate ◽  
Medical Centre ◽  
Persistent Pulmonary Hypertension

scholarly journals Management of systemic hypotension in term infants with persistent pulmonary hypertension of the newborn: an illustrated review

2021 ◽  
pp. fetalneonatal-2020-319705
Author(s):  
Heather M Siefkes ◽  
Satyan Lakshminrusimha
Keyword(s):  
Pulmonary Hypertension ◽  
Vascular Resistance ◽  
Ductus Arteriosus ◽  
Left Ventricular ◽  
Organ Injury ◽  
Persistent Pulmonary Hypertension ◽  
Impaired Left Ventricular Function ◽  
Term Infants ◽  
Systemic Hypotension ◽  
Echocardiographic Findings

In persistent pulmonary hypertension of the newborn (PPHN), the ratio of pulmonary vascular resistance to systemic vascular resistance is increased. Extrapulmonary shunts (patent ductus arteriosus and patent foramen value) allow for right-to-left shunting and hypoxaemia. Systemic hypotension can occur in newborns with PPHN due to variety of reasons, such as enhanced peripheral vasodilation, impaired left ventricular function and decreased preload. Systemic hypotension can lead to end organ injury from poor perfusion and hypoxaemia in the newborn with PPHN. Thus, it must be managed swiftly. However, not all newborns with PPHN and systemic hypotension can be managed the same way. Individualised approach based on physiology and echocardiographic findings are necessary to improve perfusion to essential organs. Here we present a review of the physiology and mechanisms of systemic hypotension in PPHN, which can then guide treatment.

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