New approaches for persistent pulmonary hypertension of newborn

Konduri, Girija G.

doi:10.1016/j.clp.2004.04.001

Cited by 68 publications

(60 citation statements)

References 108 publications

(128 reference statements)

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“…A subgroup analysis of the 176 infants enrolled at an OI of 15 to 20 in that study showed a trend for lower incidence of ECMO use/mortality (10% with Early iNO vs 18% in the Control group, P ¼ 0.12). 19,20 Also, the incidence of ECMO use in the whole study (11%) was lower than that observed in previous large clinical trials with iNO (approximately 40%). Therefore, similar to our results, these data indicate that the earlier use of iNO may be associated with further reductions in short-term respiratory morbidity.…”

Section: Discussionmentioning

confidence: 53%

Randomized controlled trial of early compared with delayed use of inhaled nitric oxide in newborns with a moderate respiratory failure and pulmonary hypertension

et al. 2009

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Objective: To evaluate whether early treatment with inhaled nitric oxide (iNO) will prevent newborns with moderate respiratory failure from developing severe hypoxemic respiratory failure (oxygenation index (OI)X40).Study Design: A total of 56 newborns with moderate respiratory failure (OI between 10 and 30) were randomized before 48 h after birth to early treatment with 20 p.p.m. of iNO (Early iNO group, n ¼ 28) or conventional mechanical ventilation with FiO 2 1.0 (Control group, n ¼ 28). Infants received iNO and/or high-frequency oscillatory ventilation (HFOV) if they developed an OI>40.Result: 7 of 28 early iNO patients (25%) compared to 17 of 28 control patients (61%) developed an OI>40 (P<0.05). In the Early iNO group mean OI significantly decreased from 22 (baseline) to 19 at 4 h (P<0.05) and remained lower over time: 19 (12 h), 18 (24 h) and 16 at 48 h. In contrast, OI increased in the Control group and remained significantly higher than the Early iNO group during the first 48 h of study: 22 (baseline), 29, 35, 32 and 23 at 4, 12, 24 and 48 h, respectively (P<0.01). Of 17, 6 control patients who developed an OI>40 were successfully treated with iNO. Nine of the remaining eleven control patients and six of seven Early iNO patients who had an OI>40 despite use of iNO responded with the addition of HFOV. One patient of the Early iNO group and two of the Control group died. Median (range) duration of oxygen therapy was significantly shorter in the Early iNO group: 11.5 (5 to 90) days compared to 18 (6 to 142) days of the Control group (P<0.03).Conclusion: Early use of iNO in newborns with moderate respiratory failure improves oxygenation and decreases the probability of developing severe hypoxemic respiratory failure.

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Section: Discussionmentioning

confidence: 53%

Randomized controlled trial of early compared with delayed use of inhaled nitric oxide in newborns with a moderate respiratory failure and pulmonary hypertension

et al. 2009

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“…2 Disturbances of cardiac performance, hypovolemia and decreased systemic vascular resistance may further compromise pulmonary blood flow in PPHN. 18 It is plausible that because of differential effects on cardiac output, the effectiveness of HFJV and HFOV differs in patients with PPHN.…”

Section: Discussionmentioning

confidence: 99%

“…2 Most often PPHN occurs in infants with meconium aspiration syndrome (34 to 51%), pneumonia/sepsis (20 to 23%), idiopathic PPHN (17 to 25%), congenital diaphragmatic hernia (10 to 15%) or respiratory distress syndrome (9 to 12%). 3,4 Prior to the introduction, in the late 1990s, of inhaled nitric oxide (iNO), therapies for PPHN included induced alkalosis, supplemental oxygen, mechanical ventilation and neuromuscular blockade; and patients who failed to respond to these measures were treated with extracorporeal membrane oxygenation (ECMO).…”

Section: Introductionmentioning

confidence: 99%

Neonatal pulmonary hypertension treated with inhaled nitric oxide and high-frequency ventilation

2008

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Term and near-term infants with pulmonary hypertension are frequently treated with inhaled nitric oxide. This therapy can be delivered with highfrequency ventilation, but there has been limited study of the relative effectiveness of high-frequency jet ventilation and high-frequency oscillatory ventilation.Objective: To compare short-term clinical outcomes of neonates with pulmonary hypertension treated with inhaled nitric oxide plus either high-frequency jet ventilation or high-frequency oscillatory ventilation.Study Design: Study infants met the following criteria: X35 weeks gestation, respiratory failure with pulmonary hypertension, no congenital malformations and treatment in the first week of life with inhaled nitric oxide plus either high-frequency jet ventilation (n ¼ 22) or high-frequency oscillatory ventilation (n ¼ 43). Data were collected from medical records. Result:The jet ventilation and oscillatory ventilation groups were similar in terms of gestational age, but the jet ventilation group had less severe respiratory illness (that is, lower oxygenation index) just prior to initiation of the combination of nitric oxide and high-frequency ventilation. The jet ventilation group spent more hours on inhaled nitric oxide (71.4 versus 40.8; P ¼ 0.004) but was less likely to require extracorporeal membrane oxygenation (2(9%) versus 19(44%); P ¼ 0.004). No difference was found in the ages at which oxygen and high-frequency ventilation were discontinued. Keywords: persistent pulmonary hypertension; inhaled nitric oxide; hypoxic respiratory failure; high-frequency ventilation; high-frequency oscillatory ventilation; high-frequency jet ventilation Introduction Persistent pulmonary hypertension of the newborn (PPHN) refers to a lack of normal cardiopulmonary adaptation following delivery, 1 including persistence of the elevated pulmonary vascular resistance that is characteristic of fetuses. 2 Most often PPHN occurs in infants with meconium aspiration syndrome (34 to 51%), pneumonia/sepsis (20 to 23%), idiopathic PPHN (17 to 25%), congenital diaphragmatic hernia (10 to 15%) or respiratory distress syndrome (9 to 12%). 3,4 Prior to the introduction, in the late 1990s, of inhaled nitric oxide (iNO), therapies for PPHN included induced alkalosis, supplemental oxygen, mechanical ventilation and neuromuscular blockade; and patients who failed to respond to these measures were treated with extracorporeal membrane oxygenation (ECMO). 5 iNO has been shown to reduce the need for ECMO in term and near-term neonates with pulmonary hypertension. 3,4,6,7 High-frequency ventilation (HFV) has been used with increasing frequency for PPHN, 8 and when combined with iNO results in an acute rise in arterial oxygen saturation, 9 and reduces the likelihood of ECMO treatment. 10 Studies of iNO delivered by HFV have, to date, utilized high-frequency oscillatory ventilation (HFOV). However, since patients treated with high-frequency jet ventilation (HFJV), as compared to conventional ventilation, require lower peak pressures to achieve t...

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“…İntrauterin dönemde kalbin sağ tarafına gelen kanın %10'u akciğerlere giderken geri kalanı patent foramen ovale (PFO) ve patent duktus arteriyozus (PDA) aracılığı ile kalbin sol tarafına ve sistemik dolaşıma aktarılır ve plasentada gaz ve besin maddeleri alışverişi yapılıp tekrar kalbin sağ tarafına döner (1). Doğumdan sonra akciğerlerin havalanması ve pulmoner vazodilatasyon ile akciğerlere giden kan 10 kat artarak sistemik akım ile eşitlenir.…”

Section: Yenidoğanın Persistan Pulmoner Hipertansiyonu (Yd-pph)unclassified

“…Doğumdan sonra pulmoner vasküler direncin azalmasını sağlayan etkenler oksijenasyon, akciğer distansiyonunu takiben kapillerlerin açılması, bradikinin, adrenomedullin, adenozin, prostasiklin ve nitrik oksit (NO) üzerinden oluşan vazodilatasyon ve daha uzun sürede vasküler yeniden yapılanmadır (3). Doğumdan sonra beklenen pulmoner vazodilatasyonun oluş-maması, pulmoner kan akımının artmaması ve soldan sağa doğru dönmesi gereken PDA ve PFO düzeyindeki şantların sağ-dan sola akmaya devam etmesi persistan pulmoner hipertansiyon (PPH) olarak tanımlanır (1). Görülme sıklığı 1.9-2/1000 canlı doğum ya da yenidoğan ünitelerinde yatan hastalar göz önüne alındığında 1-2/100 olarak bildirilmektedir (4,5).…”

Section: Yenidoğanın Persistan Pulmoner Hipertansiyonu (Yd-pph)unclassified

Pediatric pulmonary hypertension and pulmonary arterial hypertension secondary to congenital heart diseases

Olguntürk¹

2010

Anadolu Kardiyol Derg

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Causes of pulmonary arterial hypertension (PAH) are similar in adults and children. The main difference is that PAH secondary to congenital heart diseases, is the predominant cause in pediatric patients. Persistent pulmonary hypertension of the newborn shows completely different clinical course and pathophysiological mechanisms. It is usually seen in full term babies with a high morbidity and mortality rate. Improved prognosis has been reported with inhaled nitric oxide (NO) and extracorporeal membrane oxygenation therapy in babies hospitalized in well equipped and experienced newborn centers. Primary pulmonary hypertension and familial pulmonary hypertension are rare in pediatric age group because the diagnosis is initially made in adolescence. The incidence of PAH secondary to congenital heart disease is estimated as 1.6 -12.5 case/million/year. Eisenmenger syndrome is diagnosed in 1% of patients with PAH. Patients with left to right shunts are the main group who develop pulmonary vascular disease if not treated in the early infancy. Some cyanotic congenital heart diseases are also the causes of PAH. The best treatment of patients at risk for the development of pulmonary vascular disease is prevention by early surgical elimination of defects or repairing the anatomy. Treatment options with vasodilating agents like NO, prostaglandin analogs, phosphodiesterase -5 inhibitors and endothelin receptor antagonists are used to improve survival and quality of life. Heart lung or bilateral lung transplantation is the only surgical option for many of these patients. Results of national and international registries will bring valuable epidemiological and prognostic perspectives to pediatric PAH. (Anadolu Kardiyol Derg 2010; 10: Suppl 1; 50-6) Key words: Child, pulmonary hypertension, congenital heart disease ÖZET Çocuklarda görülen pulmoner arteriyel hipertansiyon (PAH) tipleri erişkinlerde görülenlerle benzerlik göstermekle birlikte daha çok doğumsal kalp hastalıklarına (DKH) ikincil olarak gelişen PAH tipi sıktır. Yenidoğan persistan pulmoner hipertansiyonu (YD-PPH) ise tamamen farklı bir mekanizma ve gidiş gösterir. YD-PPH daha çok gebelik süresini tamamlamış yenidoğanların hastalığıdır. Yüksek morbidite ve mortalite ile seyreder. Son yıllar-da tedavide inhale nitrik oksit (NO) ve ekstrakorporeal membran oksijenasyonun kullanılması, deneyimli merkez sayısının artması hastalığın seyrini önemli ölçüde değiştirmiştir. Nadir görülen primer ve ailevi PAH iyi bir anamnez ve fizik inceleme ile kuşkulanılarak tanı konulabilen ancak ilerlemiş olgularda semptomatik olan PAH türleridir. Doğumsal kalp hastalıklarına bağlı PAH sıklığı 1.6-12.5 olgu/milyon/yıl olarak bildirilmiştir. PAH'lı hastaların %1'inde Eisenmenger sendromu tanımlanmıştır. Çocuklarda soldan sağa şantlı DKH'ları pulmoner arteriyel hipertansiyonun başlıca nedenidir. DKH olan PAH'lı çocukların erken cerrahi ile tedavi edilmeleri pulmoner vasküler hastalığın önlenmesi için gereklidir. Bu hastalarda yaşam süresi ve kalitesini artırmak amacı ile vazodilatör ilaç teda...

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New approaches for persistent pulmonary hypertension of newborn

Cited by 68 publications

References 108 publications

Randomized controlled trial of early compared with delayed use of inhaled nitric oxide in newborns with a moderate respiratory failure and pulmonary hypertension

Randomized controlled trial of early compared with delayed use of inhaled nitric oxide in newborns with a moderate respiratory failure and pulmonary hypertension

Neonatal pulmonary hypertension treated with inhaled nitric oxide and high-frequency ventilation

Pediatric pulmonary hypertension and pulmonary arterial hypertension secondary to congenital heart diseases

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