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Inhaled prostacyclin for term infants with persistent pulmonary hypertension refractory to inhaled nitric oxide
Lisa K Kelly1, Nicolas F m Porta, Denise M Goodman
1Department of Pediatrics, Children's Memorial Hospital and Northwestern University Medical School, Chicago, Illinois 60614, USA.
Insights
Inhaled prostacyclin (PGI(2)) improved oxygenation in neonates with persistent pulmonary hypertension. While one infant with alveolar capillary dysplasia did not survive, the others recovered well.
Area of Science:
- Neonatal Medicine
- Pulmonary Hypertension
- Pharmacology
Background:
- Persistent pulmonary hypertension of the neonate (PPHN) is a critical condition.
- Hypoxemia refractory to inhaled nitric oxide presents a treatment challenge.
Purpose of the Study:
- To evaluate the efficacy of inhaled prostacyclin (PGI(2)) in neonates with PPHN and hypoxemia unresponsive to inhaled nitric oxide.
Main Methods:
- Case series involving 4 neonates with PPHN and refractory hypoxemia.
- Administration of inhaled prostacyclin (PGI(2)).
- Monitoring of oxygenation and clinical outcomes.
Main Results:
- Rapid improvement in oxygenation was observed in all 4 infants post-inhaled PGI(2) administration.
- Three of the four infants were discharged with normal oxygen saturation.
- One infant with underlying alveolar capillary dysplasia experienced deterioration and did not survive.
Conclusions:
- Inhaled prostacyclin (PGI(2)) appears to be a promising treatment for PPHN with hypoxemia refractory to inhaled nitric oxide.
- Careful patient selection may be important, considering underlying conditions like alveolar capillary dysplasia.
- Further research is warranted to confirm the safety and efficacy of inhaled PGI(2) in this population.
Abstract:
We report the use of inhaled prostacyclin (PGI(2)) in 4 neonates with persistent pulmonary hypertension and hypoxemia refractory to inhaled nitric oxide. Oxygenation rapidly improved after inhalation of PGI(2) 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.