Korean J Perinatol.  1999 Sep;10(3):331-337.

The Response of Sodium Nitroprusside in the Treatment of Persistent Pulmonary Hypertension of the Newborn

• Lee SL
• Kwon TC
• Kim CS

Abstract

OBJECTIVE
To evaluate the response of sodium nitroprusside(SNP) in the treatment of persistent pulmonary hypertension of the newborn(PPHN).
METHODS
Among neonates with PPHN who were admitted at the NICU of the Department of Pediatrics of Dongsan Medical Center, Keimyung University between June 1996 and May 1999, 10 cases were treated with SNP. The diagnosis of PPHN was made by echocardiography, and SNP was administered by continuous infusion via peripheral or central vein, and the initial dose was 0.5microgram/kg/min. The rate of infusion was subsequently titrated, by repeatedly increasing the rate of infusion, until a desired or adverse effect was observed, the maximal rate of SNP infusion did not exceed 0.5microgram /kg/min. Serial vital signs, arterial blood gases, platelet counts, and oxygenation index(OI) were measured before and after SNP infusion periodically. Statistical analyses were assessed by ANOVA test using SAS package. Significance was assumed at P<0.05.
RESULTS
All the patients were outborn. And fullterm, c-section delivery neonates were more common. Common associated diseases were pneumonia(including meconium aspiration syndrome, 50%), perinatal asphyxia(30%) and respiratory distress syndrome(30%). And 8 cases(80%) were improved(responsive group), 2 cases were not improved(nonresponsive group). Between both groups, there were not noted signigicant difference in mean 1-& 5-min Apgar score, arterial pH, PO2 and PCO2, maximal infusion rate and duration of SNP. Mean baseline OIs were 55.2 in responsive group and 57.9 in nonresponsive group. After SNP therapy, OI of the former was reduced significantly(p<0.005), but OI of the latter didn't change significantly. During SNP therapy, transient hypotension was developed in 3 cases, and pulmonary hemorrhage in three, and one case with necrotizing enterocolitis, thrombocytopenia, or periventricular leukomalacia was noted.
CONCLUSION
It was concluded that SNP can be used as a non-aggressive and low-cost primary treatment for the patient with PPHN.

MeSH Terms

Apgar Score
Diagnosis
Echocardiography
Enterocolitis, Necrotizing
Gases
Hemorrhage
Humans
Hydrogen-Ion Concentration
Hypertension, Pulmonary*
Hypotension
Infant, Newborn*
Leukomalacia, Periventricular
Meconium Aspiration Syndrome
Nitroprusside*
Oxygen
Pediatrics
Platelet Count
Sodium*
Thrombocytopenia
Veins
Vital Signs
Gases
Nitroprusside
Oxygen
Sodium