Inhaled Iloprost as a First-Line Therapy for Persistent Pulmonary Hypertension of the Newborn
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
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 (FiO2), 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 FiO2, 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.
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 (FiO2), 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 FiO2, 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.
참고문헌 (22)
- Nair J, "Update on PPHN: mechanisms and treatment", Semin Perinatol, 38, pp.78~91 (2014)
- Maxey DM, "Food and Drug Administration (FDA) postmarket reported side effects and adverse events associated with pulmonary hypertension therapy in pediatric patients", Pediatr Cardiol, 34, pp.1628~1636 (2013)
- Ehlen M, "Iloprost in persistent pulmonary hypertension of the newborn", Cardiol Young, 13, pp.361~363 (2003)
- Avila-Alvarez A, "Inhaled iloprost as a rescue therapy for transposition of the great arteries with persistent pulmonary hypertension of the newborn", Pediatr Cardiol, 34, pp.2027~2029 (2013)
- De Luca D, "Iloprost as ‘rescue’therapy for pulmonary hypertension of the neonate", Paediatr Anaesth, 17, pp.394~395 (2007)
- Yilmaz O, "Inhaled iloprost in preterm infants with severe respiratory distress syndrome and pulmonary hypertension", Am J Perinatol, 31, pp.321~326 (2014)
- Chotigeat U, "Inhaled iloprost for severe persistent pulmonary hypertension of the newborn", J Med Assoc Thai, 90, pp.167~170 (2007)
- Limsuwan A, "Aerosolized iloprost for postoperative pulmonary hypertensive crisis in children with congenital heart disease", Int J Cardiol, 129, pp.333~338 (2008)
- Shah PS, "Sildenafil for pulmonary hypertension in neonates", Cochrane Database Syst Rev, 3, pp.CD005494~ (2007)
- Dhillon R., "The management of neonatal pulmonary hypertension", Arch Dis Child Fetal Neonatal Ed, 97, pp.F223~F228 (2012)
- Kirbas A, "Comparison of inhaled nitric oxide and aerosolized iloprost in pulmonary hypertension in children with congenital heart surgery", Cardiol J, 19, pp.387~394 (2012)
- Badesch DB, "Medical therapy for pulmonary arterial hypertension:updated ACCP evidence-based clinical practice guidelines", Chest, 131, pp.1917~1928 (2007)
- Piastra M, "Nebulized iloprost and noninvasive respiratory support for impending hypoxaemic respiratory failure in formerly preterm infants: a case series", Pediatr Pulmonol, 47, pp.757~762 (2012)
- Eifinger F, "Aerosolized iloprost in the treatment of pulmonary hypertension in extremely preterm infants: a pilot study", Klin Padiatr, 220, pp.66~69 (2008)
- 황승경, "Use of Inhaled Iloprost in an Infant With Bronchopulmonary Dysplasia and Pulmonary Artery Hypertension", Korean Circulation Journal, 39(8), pp.343~345 (2009), 대한심장학회
- Gurakan B, "Therapeutic combination of sildenafil and iloprost in a preterm neonate with pulmonary hypertension", Pediatr Pulmonol, 46, pp.617~620 (2011)
- Mohamed WA, "A randomized, double-blind, placebocontrolled, prospective study of bosentan for the treatment of persistent pulmonary hypertension of the newborn", J Perinatol, 32, pp.608~613 (2012)
- Kahveci H, "Oral sildenafil and inhaled iloprost in the treatment of pulmonary hypertension of the newborn", Pediatr Pulmonol, 49, pp.1205~1213 (2014)
- Majed BH, "Molecular mechanisms regulating the vascular prostacyclin pathways and their adaptation during pregnancy and in the newborn", Pharmacol Rev, 64, pp.540~582 (2012)
- 한윤기, "일산화질소 흡입요법에 반응하지 않는 중증 신생아 지속성 폐동맥 고혈압증 환자에서 분무식 iloprost (Ventavis^Ⓡ)의 치료효과", Perinatology, 22(1), pp.57~63 (2011), 대한주산의학회
- Mulligan C, "Inhaled iloprost for the control of acute pulmonary hypertension in children: a systematic review", Pediatr Crit Care Med, 13, pp.472~480 (2012)
- Eronen M, "Prostacyclin treatment for persistent pulmonary hypertension of the newborn", Pediatr Cardiol, 18, pp.3~7 (1997)