Effect of tolazoline on persistent hypoxemia in severe hyaline membrane disease

Ten critically-ill preterm infants with severe hyaline membrane disease received tolazoline because of persistent hypoxemia refractory to the administration of 100% oxygen and mechanical ventilation. Seven infants (70%) responded immediately with an increase in PaO2 greater than or equal to 20 mmHg in the umbilical arterial gas within 60 minutes after bolus infusion (1 to 2 mg/kg) of tolazoline. Twenty-four hours later after the tolazoline infusion, the FiO2 had been decreased from 1.0 to a mean of 0.82 +/- 0.16, and the MAP from 16.5 +/- 1.8 to 15.6 +/- 4.5 cm H2O. Four of 7 infants (57%) who had an immediate response survived, whereas none survived out of 3 infants who failed to respond initially. Three infants experienced relatively severe complications possibly related to tolazoline. There appears to be a place for the use of tolazoline in a severely hypoxemic infant with hyaline membrane disease who is being ventilated, and in whom arterial oxygenation cannot be improved by a further increase in the inspired oxygen concentration or by an alteration of ventilator settings.

Tolazoline in persistent pulmonary hypertension of the newborn.

Thirteen critically ill infants received tolazoline because of sever hypoxaemia refractory to administration of 100 percent oxygen and mechanical ventilation (in 12 infants). Six (46.15%) responded with a mean increase in PaO2 of 151.32 torr within one hour after starting tolazoline. Only 4 of these receiving tolazaline could have the treatment stopped when oxygen requirement was 60 percent without recurrent hypoxaemia. The survival in the responders was 83 percent. Seven patients had little or no improvement in PaO2 following tolazoline and only 3 (42%) of these infants survived. The overall survival was 61 percent. All infants experienced complications possibly related to tolazoline.