Adenosine infusion for the management of persistent pulmonary hypertension of the newborn.

OBJECTIVE

To determine the effect of adenosine for the management of persistent pulmonary hypertension of the newborn.

DESIGN

Prospective, observational case series report.

SETTING

A single, tertiary referral neonatal intensive care unit.

PATIENTS

Nine neonates with persistent pulmonary hypertension of the newborn requiring mechanical ventilation and inhaled nitric oxide at 20 parts per million.

INTERVENTIONS

A continuous intravenous infusion of adenosine at 50 microg/kg/min.

MEASUREMENTS AND MAIN RESULTS

Peripheral arterial oxygen saturation, arterial oxygen tension, invasive systemic arterial blood pressure, and pulmonary arterial pressure, estimated using echocardiography, were recorded. There was a significant improvement in arterial oxygenation tension in six of nine neonates who responded to adenosine: PaO2 increased from 66.8 (range, 47-70.5) torr (8.8 kPa) to 73.5 (range, 58.5-94.2) (p=.02) and pulmonary arterial pressure decreased significantly from 63 (range, 42.5-64.0) to 43.5 (range, 32.75-49) mm Hg (p=.002). The pulmonary to systemic mean artery pressure ratio fell from 1.27 (range, 0.88-1.5) to 0.81 (range, 0.64-0.84) (p=.002). Three neonates did not respond to adenosine infusion.

CONCLUSIONS

The use of adenosine infusion in combination with inhaled nitric oxide may be a potentially valuable therapeutic option for the treatment of pulmonary hypertension of the newborn. Neonates with irreversible lung pathology may not respond to adenosine infusion.