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Objetivos: Descrever fatores de risco, perfil do recém-nascido, alterações ecocardiográficas, tratamento e desfecho da Hipertensão Pulmonar Persistente Neonatal em uma unidade de cuidados terciários na cidade de Joinville/SC, Brasil. Métodos: Estudo descritivo observacional transversal envolvendo a avaliação dos prontuários dos neonatos com sinais clínicos de hipertensão pulmonar, comprovação ecocardiográfica e internação em Unidade de Terapia Intensiva no período de um ano. Foram coletados dados fetais, maternos, ecocardiográficos, tratamentos e desfechos. Resultados: Foram estudados 29 recém-nascidos. A mediana da idade gestacional foi de 37,4 semanas, 65,5% dos partos foram realizados por via alta e 48,3% das mães realizaram acompanhamento pré-natal de alto risco. O peso de nascimento variou de 585 a 4270g, 58,6% dos pacientes eram do sexo feminino, 48,3% dos recém-nascidos apresentaram Índice de Apgar <7 no 1º minuto. Ao estudo ecocardiográfico, 62,1% dos pacientes apresentaram shunt cardíaco direito-esquerdo e a pressão pulmonar média calculada foi de 40,5 mmHg (26,3-66,0). As drogas mais utilizadas foram Milrinona, Óxido Nítrico Inalatório e Alprostadil. A amostra contou com 6 óbitos. Não houve valor de p significativo nas variáveis devido a limitação na quantidade da amostra estudada. Conclusão: O perfil do RN encontrado foi de neonatos do gênero feminino, a termo, com nascimento por via alta. Os sinais clínicos de hipertensão pulmonar foram observados na maioria dos pacientes sendo demonstrado grau leve pelas alterações ecocardiográficas. Não houve diferença significativa na comparação das medicações utilizadas e o tempo de suporte ventilatório comparado a severidade da doença. A taxa de mortalidade foi semelhante a outros estudos.
Objectives: To describe risk factors, newborn profile, echocardiographic changes, treatment and outcome of Persistent Pulmonary Hypertension of Newborn diagnosed in a hospital in the South of Brazil. Methods: This was a cross-sectional descriptive study. The research was performed with medical records of newborns presenting clinical signs of pulmonary hyperterion, echocardiographic changes and neonatal ICU for one year. Our variables included neonatal data, maternal data, echocardiographic data, treatments and outcomes. Results: We studied 29 newborns. The median gestational age was 37.4 weeks, 65.5% of deliveries were cesarean and 48.3% of mothers underwent high-risk prenatal care. Birth weight ranged from 585 to 4270 g, 58.6% were female patients, 48.3% of newborns had Apgar score <7 in the first minute. Among the echocardiographic changes, we found 62.1% of patients with right-to-left cardiac shunt and mean pulmonary pressure calculated was 40.5 mmHg (26.3-66.0). The main prescribed drugs were Milrinone, Inhaled Nitric Oxide and Alprostadil (Prostaglandin E1 agonist). The total sample had 6 deaths. Due the limitation of the amount of the sample studied, an insignificant p-value was obtained in all variables. Conclusion: The profile of the newborn was female genre, with term pregnancy, by cesarian. Clinical signs of pulmonary hypertension were observed in most of patients, and mild levels were demonstrated by echocardiographic changes. There was no significant difference in the comparison between the medications used and the duration of ventilatory support associated with the severity of the disease. The mortality rate was similar to other studies.
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Objective@#To study the clinical effect of inhaled nitric oxide(iNO) with mechanical ventilation for the neonates with persistent pulmonary hypertension of newborn(PPHN).@*Methods@#A total of 40 neonates with PPHN poorly responding with routine treatment were treated with iNO therapy.Pulmonary artery pressure, blood gas ion analysis and respiratory function changes were observed at different time points before and after iNO.@*Results@#Treatment with iNO resulted in a rapid decrease in pulmonary artery pressure from(54.95±17.08) mmHg(1 mmHg=0.133 kPa) to(20.40±14.26) mmHg.Oxygenation of 40 cases improved in the first 0.5~1 hour after iNO therapy, the values of mean airway pressure(MAP)declined from(13.98±2.40)cmH2O(1 cmH2O=0.098 kPa) to(12.44±2.69)cmH2O, oxygenation index(OI)decreased from 26.89±18.62 to 13.84±5.52, PaO2/FiO2 increased from(60.34±23.49) mmHg to(144.46±23.49) mmHg, and the value of pH increased from 7.31±0.14 to 7.37±0.07.Furthermore, within 48 hours after treatment, PaO2/FiO2 and pH increased gradually, while MAP and OI decreased gradually, which all had statistical differences(P<0.01).@*Conclusion@#Mechanical ventilation combined with iNO therapy in the treatment of PPHN can rapidly improve the oxygenation status of neonates, reduce pulmonary vascular resistance, and then improve the survival rate and long-term prognosis.
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Objective To study the clinical effect of inhaled nitric oxide ( iNO) with mechanical ventilation for the neonates with persistent pulmonary hypertension of newborn(PPHN). Methods A total of 40 neonates with PPHN poorly responding with routine treatment were treated with iNO therapy. Pulmona-ry artery pressure,blood gas ion analysis and respiratory function changes were observed at different time points before and after iNO. Results Treatment with iNO resulted in a rapid decrease in pulmonary artery pressure from(54. 95 ± 17. 08) mmHg(1 mmHg＝0. 133 kPa) to(20. 40 ± 14. 26) mmHg. Oxygenation of 40 cases improved in the first 0. 5 ~1 hour after iNO therapy,the values of mean airway pressure(MAP) de-clined from(13. 98 ± 2. 40) cmH2 O(1 cmH2 O＝0. 098 kPa) to(12. 44 ± 2. 69) cmH2O,oxygenation index (OI)decreased from 26. 89 ± 18. 62 to 13. 84 ± 5. 52,PaO2/FiO2 increased from(60. 34 ± 23. 49) mmHg to (144. 46 ± 23. 49) mmHg,and the value of pH increased from 7. 31 ± 0. 14 to 7. 37 ± 0. 07. Furthermore, within 48 hours after treatment,PaO2/FiO2 and pH increased gradually,while MAP and OI decreased gradu-ally,which all had statistical differences(P<0. 01). Conclusion Mechanical ventilation combined with iNO therapy in the treatment of PPHN can rapidly improve the oxygenation status of neonates,reduce pulmonary vascular resistance,and then improve the survival rate and long-term prognosis.
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Introducción: Las patologías que podrían motivar el ingreso a una Sala de Reanimación (SR) son múltiples, y asimismo, presentarse en cualquier momento, independientemente del sexo y la edad. A pesar de esta versatilidad, no existen investigaciones que describan la realidad chilena y la literatura extranjera es escasa. En consecuencia, nuestro estudio buscó caracterizar clínico-demográficamente a los pacientes ingresados a SR del Hospital San Juan de Dios de Los Andes, Chile. Materiales y métodos: Estudio de corte transversal. Se trabajó con base de datos anonimizada. El tamaño muestral calculado fue de al menos 1014 sujetos (intervalo de confianza de 95%, precisión de 3%). Se incluyeron los ingresos entre enero de 2013 y junio de 2016, obteniendo una muestra de 1018 pacientes. Variables estudiadas: sexo, edad, diagnóstico general, diagnóstico específico, mes y horario. Se trabajó con Microsoft Excel® utilizando estadística descriptiva. Aprobado por comité éticocientífico. Resultados: 58,1% (n=593) hombres; 42,5% (n=434) mayores de 64 años. Diagnósticos generales más frecuentes: cardiovascular (50,3%) (n=512), neurológico (16,3%) (n=166) y traumático (11,7%) (n=119). Diagnósticos específicos más frecuentes: taquiarritmia (15,9%) (n=162) e infarto miocárdico (12,6%) (n=128). La mayor cantidad de ingresos se registró en enero, febrero y junio (promedio 28 ingresos), y entre las 20 y 00 hrs (22,8%) (n=232). Discusión: Existe un amplio predominio de las enfermedades cardiovasculares.La distribución por mes, sexo y edad parece estar supeditada al comportamiento de dicho grupo; no así la distribución por horarios, ya que las enfermedades cardiovasculares suelen presentarse matinalmente. En general, nuestros resultados coinciden con la literatura extranjera disponible
Introduction: Neonatal pulmonary hypertension (NPHT) caused by chronic hypobaric hypoxia during gestation is associated with oxidative stress and currently lacks of an effective treatment. The aim of this study was to evaluate the effects of melatonin administrated on pregnant sheep on endothelium-dependent vascular reactivity and expression of eNOS, COX-1 and COX-2 on the lungs of lambs gestated and born under chronic hypobaric hypoxia. Material and method: Ten pregnant ewes under chronic hypoxia of highlands (3600 masl) were divided in two groups: 1. Control group (CN), treated with vehicle (5 ml/d ethanol 1, 4%), and 2. Melatonin group (MM), treated with melatonin during gestation (10 mg/d in 5 ml ethanol 1, 4%), during the last third of gestation. Results: Ewes gave birth spontaneously and without assistance, and we obtained lung tissue from 12 days old lambs to determine endothelial vascular reactivity by wire myography. In addition, eNOS, COX-1 and COX-2 RNA and protein expression were measured through RT-PCR and Western Blot, respectively. Discussion: The endothelium dependent vasodilation response was significantly enhanced in MM. Further, MM showed a significant increase in eNOS, COX-1 and COX-2 protein levels, relative to CN group. In conclusion, prenatal melatonin induces endothelium dependent vasodilation mechanisms and positively modulates eNOS-NO and prostanoids pathways, which may favour a treatment for NPHT caused by chronic hypoxia at high-altitude
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Animals , Pulmonary Arterial Hypertension/drug therapy , Melatonin/administration & dosage , Hypoxia/drug therapy , Vasodilator Agents/administration & dosage , Lung DiseasesABSTRACT
OBJECTIVE:To observe clinical efficacy and safety of milrinone in the treatment of persistent pulmonary hyperten-sion of newborn. METHODS:52 newborns with persistent pulmonary hypertension were divided into control group and observa-tion group according to random number table,with 26 cases in each group. The control group were given mechanical ventilation and intravenous prostaglandin therapy. Observation group was treated with Milrinone injection at loading dose of 50 μg/kg,10 min intravenous injection,maintenance dose of 0.75 μg/(kg·min). Both groups received treatment for 48 h. Clinical efficacies of 2 groups were compared as well as SpO2,PaO2,OI,PAP,PAMP and SV before and after treatment. The occurrence of ADR was compared between 2 groups. RESULTS:Total effective rate of observation group was 92.31%,which was significantly higher than 80.77% of control group,with statistical significance (P0.05). After treatment,above indexes of 2 groups were im-proved significantly;SpO2,PaO2,OI and SV levels of observation group were significantly higher than those of control group, while PAP and PAMP levels were significantly lower than those of control group,with statistical significance(P<0.05). No obvi-ous ADR was found in 2 groups. CONCLUSIONS:Milrinone shows significant therapeutic efficacy in the treatment of persistent pulmonary hypertension of newborn,and can significantly improve persistent pulmonary hypertension and increased oxygen con-tent of blood with good safety.
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PURPOSE: We aimed to evaluate the effect of admission hypothermia on neonatal outcomes in very low birth weight infants (VLBWIs). METHODS: Medical records of 153 preterm infants, with birth weights <1,500 g and gestational ages <32 weeks, were retrospectively reviewed. The clinical characteristics and neonatal outcomes in infants who experienced moderate hypothermia during the first hour of life (Group I) were compared to those in infants with mild hypothermia or normothermia (Group II). RESULTS: Fifty of 153 infants experienced moderate hypothermia after birth. Group I had lower birth weight than Group II (867.8±304.4 g vs. 1,140.3±247.5 g, P<0.001), and were younger than Group II (27.6±2.6 weeks vs. 29.1±1.9 weeks, P<0.001). Adjusted proportion of moderate to severe bronchopulmonary dysplasia (BPD) and persistent pulmonary hypertension of newborn (PPHN) were higher in Group I than in Group II (56% vs. 21.8%, P=0.005), (9.1% vs. 1.5%, P=0.019). Multiple logistic regression analysis that did not control for PPHN (model II) showed that gestational age (Odds ratio [OR] 0.93, P=0.001), moderate hypothermia (OR 4.07, P=0.013), and surgical patent ductus arteriosus (OR 4.96, P=0.023) were associated with moderate to severe BPD. Association of moderate hypothermia with moderate to severe BPD was invalid when further multiple logistic regression analysis adjusting for PPHN (model I), which had a strong association with moderate to severe BPD (OR=15.46, P=0.039), was performed. CONCLUSION: Moderate hypothermia after birth in VLBWIs was associated with PPHN and moderate to severe BPD. The association between moderate hypothermia and moderate to severe BPD might be mediated by PPHN.
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Female , Humans , Infant , Infant, Newborn , Birth Weight , Bronchopulmonary Dysplasia , Ductus Arteriosus, Patent , Gestational Age , Hypothermia , Infant, Premature , Infant, Very Low Birth Weight , Logistic Models , Medical Records , Parturition , Persistent Fetal Circulation Syndrome , Retrospective StudiesABSTRACT
Nitric oxide (NO) is a colorless, odorless gas that acts as a potent pulmonary vasodilator. When administered via inhalation, NO rapidly diffuses across the alveolarcapillary membrane and binds to hemoglobin, and thus has little effect on the systemic circulation. NO was approved by the United States Food and Drug Administration (US FDA) for the treatment of hypoxic respiratory failure associated with pulmonary hypertension in 1999. Neonatal hypoxic respiratory failure may be caused by persistent pulmonary hypertension of the newborn and other diseases such as meconium aspiration syndrome, sepsis, birth asphyxia, and respiratory distress syndrome that contribute to pulmonary arterial hypertension. Inhaled NO is the only approved treatment in term and late preterm (>34 weeks) neonates with hypoxic respiratory failure associated with pulmonary hypertension, and it reduces the need for extracorporeal membrane oxygenation. The present article will review the clinical indications for US FDA-approved inhaled NO therapy according to evidence-based clinical studies.
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Female , Humans , Infant, Newborn , Asphyxia , Extracorporeal Membrane Oxygenation , Hypertension , Hypertension, Pulmonary , Inhalation , Meconium Aspiration Syndrome , Membranes , Nitric Oxide , Parturition , Persistent Fetal Circulation Syndrome , Respiratory Insufficiency , Sepsis , United States Food and Drug AdministrationABSTRACT
Persistent pulmonary hvpertension of newborn(PPHN) is a life-threatening condition which occurs at a rate of 2/1 000-6/1 000.The etiology of PPHN is still unknown and its treatment remains a major challenge for neonatologist.Impaired pulmonary artery relaxation,reduced blood vessel density and pulmonary vascular remodeling are the main pathological changes in PPHN.The general managements include mechanical ventilation,sedation,surfactant and hemodynamic support.Inhaled nitric oxide is the main vasorelaxant used in the treatment of PPHN.Several other vasorelaxants have been studied such as phosphodiesterase inhibitors,prostacyclin,endothelin-1 inhibitors.Even with the introduction of several new therapeutic modalities there has been no significant change in survival rate.
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Over the last few years, sildenafil is increasingly being used in the neonatal ICU for a variety of indications. The use is even more so in the developing world due to the limited availability of nitric oxide and extracorporeal membrane oxygenation (ECMO). There are still no clear cut guidelines for its use. At present the drug appears relatively safe and effective when other treatment options have been optimized. However, the use of sildenafil must be monitored and reported. Due to its easy availability and ease of administration we must guard against its inappropriate use.
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Background: Developmental disabilities have been reported in infants with persistent pulmonary hypertension of the newborn (PPHN) treated with inhaled nitric oxide (INO) or intravenous magnesium sulphate (MgSO4) and/or extracorporeal membrane oxygenation. This paper reports the rate of developmental disabilities at 2 years of age in a cohort of survivors of PPHN treated with INO, MgSO4, or both during the neonatal period. Methods: Sixteen survivors of PPHN were prospectively followed up. These infants were treated with intravenous MgSO4 and/or INO during the neonatal period. Neurodevelopmental assessment was carried out at 2 years of age using the Bayley Scales of Infant Development 2nd Edition by a developmental psychologist. Eleven (68.8%) infants completed the 2-year follow-up. Results: The median mental developmental index (MDI) and physical developmental index scores were 85 (interquartile range, IQR = 27) and 87 (IQR = 33), respectively. Two infants (18.2%) had developmental disability (MDI scores <70). Conclusion: Survivors of PPHN are at risk of developmental disabilities. Early intervention programme and long-term follow-up should be integrated in the management of these infants.
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Persistent pulmonary hypertension of newborn (PPHN) is a clinical syndrome,characterized by pulmonary arterial pressure elevated relative to systemic blood pressure,leading to extrapulmonary right-to-left shunting of blood across the ductus arteriosus and foramen ovale,causing severe hypoxemia.Pulmonary vascular remodeling is pathognomonic of hypoxia-induced PPHN.The regulatory mechanism and cell composition of vascular wall were dysfunction,which led to vascular wall thickened.The review focus on three aspects,such as endothelial cells,smooth muscle cells,and adventitial cells,described the relation and the possible mechanisms between hypoxia-induced PPHN and pulmonary vascular remodeling.
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Nitric oxide, an endothelium-derived relaxing factor, is a selective pulmonary vasodilator. We have built and settled down the delivery system of nitirc oxide gas inhalation for the first time in Korea. Two newborn babies delvelped near fatal pulmonary hypertension after surgical repair of a congenital diaphragmatic hernia. All conventional therapeutic measures failed. So we decided to attempt to use of nitric oxide gas for treatment. Addition of ntiric oxide of 1-80 parts per million to the inspired gas allowed resolution of pulmonary hypertension. No side effect of nitric oxide therapy was observed, and ventilatory support could be substantially reduced as a result of treatment and could be stopped later. On the basis of the striking and lifesaving effects of nitric oxide therapy shown in these cases, we believe that nitric oxide inhalation can be used as a major treatment modality in the management of persistent pulmonary hypertension of the newborn.