Neonatal Med.  2019 Nov;26(4):191-197. 10.5385/nm.2019.26.4.191.

Inhaled Iloprost as a First-Line Therapy for Persistent Pulmonary Hypertension of the Newborn

• Kim SH
• Lee HJ
• Kim NS
• Park HK

• KMID: 2466638
• DOI: http://doi.org/10.5385/nm.2019.26.4.191

Abstract

PURPOSE
Persistent pulmonary hypertension of the newborn (PPHN) is a potentially fatal disease. Inhaled iloprost, a stable analogue of prostacyclin, has recently been used as a therapeutic option. However, there are no clinical guidelines on the use of iloprost, specifically for neonates. This study aimed to suggest the use of inhaled iloprost as a rescue therapy for PPHN based on our experience.
METHODS
The efficacy and adverse events of inhaled iloprost were evaluated prospectively in nine full-term neonates with PPHN. We monitored the following parameters: fraction of inspired oxygen (FiOâ‚‚), respiratory severity score (RSS), heart rate, and mean blood pressure.
RESULTS
The inhalation dose was 1 to 2 µg/kg initially, and 4 to 8 inhalations per day were applied over 2 to 8 days, except in the case of one neonate who died 2 days after birth. Echocardiographic findings, changes in FiOâ‚‚, and RSS improved within the next 7 days in eight of the nine patients. Severe side effects on heart rate and blood pressure were not observed.
CONCLUSION
Our experience suggests that inhaled iloprost can be used as a first-line treatment in newborn infants with PPHN when inhaled nitric oxide is not available. To the best of our knowledge, this report is the first prospective case series on the use of inhaled iloprost in PPHN.

Keyword

Inhaled iloprost; Prostacyclin; Persistent fetal circulation syndrome

MeSH Terms

Blood Pressure
Echocardiography
Epoprostenol
Female
Heart Rate
Humans
Hypertension, Pulmonary*
Iloprost*
Infant, Newborn*
Inhalation
Nitric Oxide
Oxygen
Parturition
Persistent Fetal Circulation Syndrome
Prospective Studies
Epoprostenol
Iloprost
Nitric Oxide
Oxygen

Figure

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  Figure 1. (A) Changes in the fraction of inspired oxygen (FiO2) values before and during iloprost therapy in neonates with persistent pulmonary hypertension of the newborn. (B) The changes in respiratory severity score before and after inhaled iloprost therapy in neonates with persistent pulmonary hypertension of the newborn. *P-value between before and 24 hours after iloprost; † Expired during therapy. Abbreviations: Pre, before the use of iloprost; Post, after the use of iloprost.

• 

  Figure 2. (A) Heart rate and (B) mean blood pressure (mBP) trends before and 24 hours after the start of iloprost therapy. P-values between timepoints are insignificant.

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