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Updated: Nov 3, 2025

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Published on: May 11, 2015
Life-threatening PPHN refractory to nitric oxide: proposal for a rational therapeutic algorithm
Feriel Fortas1, Matteo Di Nardo2, Nadya Yousef1
1Division of Pediatrics and Neonatal Critical Care, Service de Réanimation Néonatale Hôpital "A.Béclère" Medical Center, Paris Saclay University Hospitals, APHP, 157 rue de la Porte de Trivaux, 92140, Clamart, Paris, France.
A new algorithm guides treatment for persistent pulmonary hypertension of the neonate (PPHN) unresponsive to inhaled nitric oxide. It leverages updated pathobiology and pharmacology for better neonatal critical care outcomes.
Area of Science:
- Neonatal critical care
- Pulmonary hypertension pathobiology
- Pharmacology
Background:
- Persistent pulmonary hypertension of the neonate (PPHN) refractory to inhaled nitric oxide (iNO) poses a significant clinical challenge.
- 30-40% of iNO-treated neonates develop refractory PPHN, leading to poor outcomes.
- Improved understanding of pulmonary hypertension pathobiology has introduced several new pulmonary vasodilators.
Purpose of the Study:
- To provide a comprehensive, pathobiology-driven clinical algorithm for managing refractory PPHN.
- To synthesize current knowledge on novel vasodilators for neonatal use.
- To offer expert guidance for optimizing treatment strategies.
Main Methods:
- Review of recent pathobiology and pharmacology of pulmonary vasodilators.
- Expert consensus on clinical application in refractory PPHN.
- Development of a rational, step-by-step treatment algorithm.
Main Results:
- Novel vasodilators target diverse pathways with potential additive effects.
- Available agents possess distinct pharmacological profiles.
- The study synthesizes this information into a cohesive treatment strategy.
Conclusions:
- A novel clinical algorithm is presented for refractory PPHN management.
- The algorithm integrates expert advice with current pathobiology and pharmacology.
- This approach aims to improve outcomes in challenging neonatal critical care cases.
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