A case of persistent pulmonary hypertension of the newborn: Treatment with inhaled iloprost

다국어 초록 (Multilingual Abstract)

We report a case of a full-term neonate with persistent pulmonary hypertension who developed asphyxia after birth and was treated with iloprost. The neonate had persistent hypoxia and did not respond to supportive treatment. Because inhaled nitric oxide (iNO) was not available in our hospital, inhaled iloprost was administered via an endotracheal tube. This resulted in an immediate elevation of oxygen saturation. Echocardiography revealed the conversion of the right- to-left ductal shunt to the left-to-right one and a decrease of the right ventricular pressure. The use of inhaled iloprost did not cause any significant side effects. Here, we describe our experience where iloprost was used in a neonate with persistent pulmonary hypertension because the standard therapy with inhaled nitric oxide was not available.

참고문헌 (Reference)

1 de Wit C, "Synergistic action of vasodilators that increase cGMP and cAMP in the hamster cremaster microcirculation" 28 : 1513-1518, 1994

2 Kinsella JP, "Randomized, multicenter trial of inhaled nitric oxide and high-frequency oscillatory ventilation in severe, persistent pulmonary hypertension of the newborn" 131 : 55-62, 1997

3 Eronen M, "Prostacyclin treatment for persistent pulmonary hypertension of the newborn" 18 : 3-7, 1997

4 Santak B, "Prostacyclin aerosol in an infant with pulmonary hypertension" 154 : 233-235, 1995

5 Weinberger B, "Pharmacologic therapy of persistent pulmonary hypertension of the newborn" 89 : 67-79, 2001

6 Walsh-Sukys MC, "Persistent pulmonary hypertension of the newborn in the era before nitric oxide: practice variation and outcomes" 105 : 14-20, 2000

7 Finer NN, "Nitric oxide for respiratory failure in infants born at or near term" 18 : CD000399-, 2006

8 Aschner JL, "New therapies for pulmonary hypertension in neonates and children" 26 : 132-135, 2004

9 Konduri GG, "New approaches for persistent pulmonary hypertension of newborn" 31 : 591-611, 2004

10 Kelly LK, "Inhaled prostacyclin for term infants with persistent pulmonary hypertension refractory to inhaled nitric oxide" 141 : 830-832, 2002

11 Rimensberger PC, "Inhaled nitric oxide versus aerosolized iloprost in secondary pulmonary hypertension in children with congenital heart disease: vasodilator capacity and cellular mechanisms" 103 : 544-548, 2001

12 Davidson D, "Inhaled nitric oxide for the early treatment of persistent pulmonary hypertension of the term newborn: a randomized, double-masked, placebo-controlled, dose-response, multicenter study. The I-NO/PPHN Study Group" 101 : 325-334, 1998

13 Roberts JD Jr, "Inhaled nitric oxide and persistent pulmonary hypertension of the newborn. The Inhaled Nitric Oxide Study Group" 336 : 605-610, 1997

14 Soditt V, "Improvement of oxygenation induced by aerosolized prostacyclin in a preterm infant with persistent pulmonary hypertension" 23 : 1275-1278, 1997

15 Ehlen M, "Iloprost in persistent pulmonary hypertension of the newborn" 13 : 361-363, 2003

16 De Luca D, "Iloprost as 'rescue' therapy for pulmonary hypertension of the neonate" 17 : 394-395, 2007

17 Cassin S, "Effects of prostacyclin on the fetal pulmonary circulation" 1 : 197-207, 1981

18 Hill LL, "Combined inhaled nitric oxide and inhaled prostacyclin during experimental chronic pulmonary hypertension" 86 : 1160-1164, 1999

19 Bindl L, "Aerosolized prostacyclin for pulmonary hypertension in neonates" 71 : F214-F216, 1994