Nitroglycerin Treatment in Persistent Pulmonary Hypertension of the Newborn

Kim, Ji Sook; Jeon, Sung Sook; Seo, Son Sang

Abstract

PURPOSE
Persistent pulmonary hypertension (PPHN) of the newborn has been treated with some vasodilators including tolazoline. But these drugs have many side effects, especially systemic hypotension . To investigate the usefulness of the nitroglycerin as a specific vasodilator with few side effects, this study was done.
METHODS
Nitroglycerin was administered within 1st one day after birth in 8 newborn infants who were diagnosed as PPHN by echocardiography. They were born at Il Sin hospital from March 1994 to March 1996. Nitroglycerin was started as 2microgram/kg/min and its maximum dose was 6microgram/kg/min. Muscle relaxants and inotropic drugs were used together in all cases. Arterial blood gas analysis, systemic blood pressure, heart rate, renal function and electrolyte were checked in all patients. Alveolar-arterial oxygen difference (AaDO2) and oxygenation index (OI) were measured.
RESULTS
6 cases (75%) survived but 2 cases expired due to air leak.1) Basal mean AaDO2 was 631.4+/-21.7mmHg. It decreased to 493.9+/-1453.1 mmHg at 10hr after loading infusion and to 373.6+/-217.7mmHg at 48hr (P<0.05). 2) Basal mean OI was 35.1+/-15.7 and it decreased significantly to 12.6+/-14.8 (P<0.05) at 10hr. 3) There was no significant hypotension in systolic, diastolic and mean blood pressure during treatment of nitroglycerin. 4) There was no significant change in renal function, serum electrolyte and heart rate during treatment of nitroglycerin.
CONCLUSIONS
Nitroglycerin produced systemic venodilatation and pulmonary arterial dilatation at the dose that produce only minimal systemic arterial dilatation. Nitroglycerin is an effective and safe drug in the treatment of PPHN.