Treatment of Persistent Pulmonary Hypertension of the Newborn with Magnesium Sulphate

ABSTRACT

PURPOSE: MgSO4 was used to evaluate the clinical effects in the treatment of severe persistent pulmonary hypertension of the newborn(PPHN). METHODS: Seven newborn infants with severe PPHN, and a persistent elevation of AaDO2(Alveolar-arterial oxygen tension difference) above 610 mmHg for more than 8 hours despite the aggressive conventional therapy were included. A loading dose of 200 mg/kg MgSO4 was given intravenously over 20-30 minutes, followed by continuous infusion of 20-50 mg/kg/hour. Vital signs, arterial blood gases, serum electrolytes, calcium and magnesium, and ventilatory setting were measured and recorded before MgSO4 was given and periodically thereafter. Severity of impairment of gas exchange was evaluated by AaDO2 and oxygenation index(OI). RESULTS: Mean gestational age and birth weight of seven infants were 38+5 weeks and 2,949844 grams, and one of them was a premature infant with gestational age of 27 weeks, and birth weight of 1,096 grams. There were six males and one female. Four infants were outborn. Four infants were presented with meconium aspiration syndrome, one with birth asphyxia, one with respiratory distress syndrome, and one with subdural hemorrhage. Before the start of the MgSO4 treatment, the mean AaDO2 and OI of seven infants were 638.8+/-10.8 mmHg and 43.811.2, respectively. During the treatment AaDO2 and OI significantly decreased to 538.4+/-114.5 mmHg and 13.4+/-9.4 within 24 hours(P< 0.05). Hypermagnesemia was noted in 7 infants, hypocalcemia in three, bradycardia in five, and hypotension in two. Only one infant was discharged against medical advice, and remaining six survived. CONCLUSION: MgSO4 may be considered as an alternative treatment of severe PPHN when other conventional treatments fail, are contraindicated, or not available.