Persistent Pulmonary Hypertension of the Newborn Successfully Treated with Beraprost Sodium: A Retrospective Chart Review

Abstract

Background: Persistent pulmonary hypertension of the newborn (PPHN) is one of the most serious conditions in neonates resulting in a high mortality and morbidity. New alternative therapies for PPHN have been sought to improve survival and reduce morbidity. Objectives: To report an initial experience of using beraprost sodium (BPS) to treat infants with PPHN and to assess its effect on oxygenation and hemodynamic stability over a 72-hour study period. Methods: The clinical data of neonates who received BPS as an adjunctive therapy for PPHN in our hospital between July 2007 and June 2008 were retrospectively reviewed. Results: During the study period, 7 infants with PPHN were successfully treated with BPS. The mean gestational age and birth weight were 39.3 ± 1.5 weeks and 3,365.7 ± 569.8 g, respectively. BPS was initiated at a median age of 42.7 h after birth (range: 2.1–166.5 h) with a baseline mean oxygen index (OI) of 33.9 ± 15.7 and a baseline mean systolic blood pressure (SBP) of 79.4 ± 9.9 mm Hg. The mean difference of OI at 24, 48 and 72 h following the treatment was –15.7 ± 14.8 (p = 0.043), –18.2 ± 12.3 (p = 0.018) and –16.7 ± 17.5 (p = 0.042), respectively. The mean SBP was significantly reduced as early as 6 h after initiation of treatment (–11.1 ± 11.5 mm Hg, p = 0.034) without changes in heart rate. Three cases were complicated with chronic lung disease, and the remaining 4 cases were normal at hospital discharge. No neurodevelopmental and cardiopulmonary disorders were observed in all cases at 1 year of age. Conclusions: BPS may be used as an alternative treatment for infants with PPHN giving a significant improvement in oxygenation.

Prostaglandin E1 use during neonatal transfer: potential beneficial role in persistent pulmonary hypertension of the newborn

“…This is consistent with previous observations of improved oxygenation in PPHN treated with PGE 1 analogue 2. The mechanism of this effect could be the known pulmonary vasodilating effects of PGE 1 ,3 and the benefits of maintaining ductal patency as a ‘blow-off’ valve to improve function in the pressure and volume-loaded right ventricle 4…”

Update on PPHN: Mechanisms and treatment

“…Use of the oral PGI 2 analog Beraprost sodium as reported from Thailand, has caused significant improvement in the oxygenation index in five neonates with PPHN who did not respond to alkali therapy and HFOV. 92 Another analog, Iloprost, has also been used endotracheally and in the inhaled form along with iNO in intractable PPHN. 93 As yet there are no randomized controlled trials evaluating the effect of these vasodilators and consequently their use remains limited.…”

Pharmacologic strategies in neonatal pulmonary hypertension other than nitric oxide

“…In a case series of 7 infants with PPHN refractory to alkali therapy and high frequency ventilation, beraprost reduced OI but also decreased systemic blood pressure by an average of 11 mm Hg by 6 hours 57 . In this study, infants received a 1µg/kg of beraprost every 6 hours.…”