Safety and Tolerability of Continuous Inhaled Iloprost Therapy for Severe Pulmonary Hypertension in Neonates and...

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Pharmacology

Background:

• Pulmonary hypertension (PH) poses a significant risk to critically ill neonates and infants.
• Refractory PH often requires rescue therapy, but options for this vulnerable population are limited.
• Continuous inhaled iloprost has emerged as a potential rescue therapy.

Purpose of the Study:

• To assess the safety and tolerability of continuous inhaled iloprost.
• To evaluate iloprost as rescue therapy for refractory PH in critically ill neonates and infants.
• To determine the impact of iloprost on key physiological parameters and clinical outcomes.

Main Methods:

• Single-center retrospective study involving 58 infants with refractory PH.
• Data collected at multiple time points after iloprost initiation (baseline to 72 hours).
• Analysis of primary outcomes (heart rate, FiO2, MAP, BP, OI) and secondary outcomes (ECMO use, mortality).

Main Results:

• Significant decreases observed in fraction of inspired oxygen (FiO2) and oxygenation index (OI) (p < 0.001, p = 0.01).
• No significant changes noted in mean airway pressures (MAP), blood pressure (BP), or heart rate (HR).
• 47% of patients recovered without ECMO; 23% died. Seven patients were bridged off ECMO with iloprost.

Conclusions:

• Continuous inhaled iloprost demonstrates an acceptable safety and tolerability profile.
• Iloprost serves as a viable add-on therapy for refractory PH in critically ill infants in the NICU.
• Further large-scale prospective multicenter studies are needed to validate these findings in neonatal ICUs.