Management of Pulmonary Arterial Hypertension in the Neonatal Unit

Krishnan, Usha

doi:10.1097/crd.0b013e3181ce9edb

Cited by 9 publications

(7 citation statements)

References 17 publications

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“…In addition to the effects on the developing lungs, premature birth and subsequent changes related to mechanical ventilation also affect the normal development of the pulmonary vasculature, which leads to narrowing of the vessels, decreased vascular compliance, and vascular remodeling. This process can lead to increased pulmonary vascular resistance (PVR) and pulmonary hypertension [ 1 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Goals of PH treatment include increasing survival as well as minimizing other complications of prematurity, which, thereby, supports pulmonary growth and development [ 21 ]. Routine treatment involves proper nutrition, respiratory management with target saturations between 92–95%, pH balance, avoidance of respiratory infections, and treatment of contributing comorbidities including aspiration, gastroesophageal reflux disease (GERD), structural airway disease, pulmonary artery and vein stenosis, left ventricular diastolic dysfunction, and closure of cardiac shunts if they contribute to excessive pulmonary blood flow [ 2 , 14 , 15 , 16 ]. Inhaled nitric oxide (iNO) has been shown to acutely lower PAP in these patients and is often used as a component of the treatment regimen, especially in the acute setting [ 21 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

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Targeted Therapy for Pulmonary Hypertension in Premature Infants

et al. 2020

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Pulmonary hypertension (PH) is common in premature infants with bronchopulmonary dysplasia (BPD) and is associated with significant mortality. Despite expert consensus suggesting the use of targeted therapies such as phosphodiesterase inhibitors, endothelin receptor antagonists, and prostanoids, there is little data on safety and outcomes in infants with BPD-associated PH (BPD-PH) treated with these medications. We sought to describe the pharmacologic management of BPD-PH and to report outcomes at our institution. Premature infants with BPD-PH born between 2005 and 2016 were included. Follow-up data were obtained through January 2020. A total of 101 patients (61 male, 40 female) were included. Of these, 99 (98.0%) patients were treated with sildenafil, 13 (12.9%) with bosentan, 35 (34.7%) with inhaled iloprost, 12 (11.9%) with intravenous epoprostenol, and nine (8.9%) with subcutaneous treprostinil. A total of 33 (32.7%) patients died during the study period and 10 (9.9%) were secondary to severe to pulmonary hypertension. Of the surviving patients, 57 (83.8%) had follow-up data at a median of 5.1 (range 0.38–12.65) years and 44 (77.2%) were weaned off PH medications at a median 2.0 (range 0–8) years. Mortality for BPD-PH remains high mostly due to co-morbid conditions. However, for those patients that survive to discharge, PH therapies can frequently be discontinued in the first few years of life.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Targeted Therapy for Pulmonary Hypertension in Premature Infants

et al. 2020

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“…Previous data suggest that sildenafil citrate has a rapid onset of action, which is evident in treatment of neonatal persistent pulmonary arterial hypertension. 8,9 FiO 2 requirement and highest capillary pCO 2 within the 24 h before starting, 24 h after starting and 48 h after starting sildenafil citrate were also recorded.…”

Section: Baseline Assessmentmentioning

confidence: 99%

“…6,7 Sildenafil citrate has also been used in infants with BPD-associated PH, focusing on long-term treatment and improvement in hemodynamics. 8,9 However, to our knowledge, no reports have described concomitant changes in pulmonary gas exchange at initiation of sildenafil citrate in infants treated for BPD-associated PH. We report a 5-year experience of treating BPD-associated PH with sildenafil citrate.…”

Section: Introductionmentioning

confidence: 99%

Sildenafil citrate, bronchopulmonary dysplasia and disordered pulmonary gas exchange: any benefits?

et al. 2011

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Objective: The objective of this study is to determine the effects that sildenafil citrate has on gas exchange in infants with bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH).Study Design: A retrospective review was performed from 2005 to 2009. Infants treated with sildenafil citrate for greater than 48 h were included. Standard patient data was collected, including echocardiogram, inspired oxygen and systemic blood pressure, before and during administration of sildenafil citrate.Result: Sildenafil citrate was used in 21 preterm infants with BPDassociated PH. A significant reduction in estimated right ventricular peak systolic pressure was seen after initiation of sildenafil citrate, with the majority of infants showing no improvement in gas exchange at 48 h of treatment. Four infants died during treatment. Conclusion:Sildenafil citrate reduced estimated pulmonary artery pressures, but this reduction was not reflected in improved gas exchange within the first 48 h.

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“…Inhaled nitric oxide (iNO), and extracorporeal membrane oxygenation (ECMO) are used when conventional treatment fails. Use of surfactant may also be beneficial therapy especially with lung parenchymal disease [3][4][5][6][7][8]. Unfortunately , in our part of the world, high frequency ventilation, ECMO and iNO delivery requires dedicated , expensive facilities that may not be available in every neonatal intensive care unit (NICU).…”

Section: Introductionmentioning

confidence: 99%

Impact of Management Strategies on the Outcome of Persistent Pulmonary Hypertension of the Newborn

Agha¹,

Tantawy²,

Iskander³

et al. 2017

Cardiol Cardiovascmed

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Objectives: To evaluate the associated risk factors and to determine the impact of management strategies on the outcome of PPHN.Study Design: Prospective descriptive study in tertiary center included 40 neonates having PPHN. All patients received the conventional therapy for PPHN, sildenafil as adjuvant therapy was added in cases of failure. Results:The study included 23 males, 17 females with a mean gestational age 37.25 ± 2.6 weeks. Male patients had significantly higher systolic pulmonary artery pressure (SPAP) and higher mortality rate compared to females [7/23 (30.4%) versus 1/17 (5.9%), p = 0.04]. Infants of diabetic mothers had significantly higher mortality rate (p = 0.003). Components of the blood gases; PH, PCO 2 , HCO 3 improved dramatically after completion of the different lines of treatment (p = 0.001). A statistical significant drop of SPAP after application of the different modalities of treatment (p = 0.001). Addition of sildenafil was effective in the reduction of the duration of NICU stay and SPAP below 40 mmHg and (p = 0.001, p =0.0001, respectively). The overall mortality rate was 8/40 neonates (20%), however, the mortality among the patients who received sildenafil in addition to conventional therapy was 1/14 neonates (7.14%) of those group with p = 0.001).

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Management of Pulmonary Arterial Hypertension in the Neonatal Unit

Cited by 9 publications

References 17 publications

Targeted Therapy for Pulmonary Hypertension in Premature Infants

Targeted Therapy for Pulmonary Hypertension in Premature Infants

Sildenafil citrate, bronchopulmonary dysplasia and disordered pulmonary gas exchange: any benefits?

Impact of Management Strategies on the Outcome of Persistent Pulmonary Hypertension of the Newborn

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