Division of Neonatology, Department of Pediatrics, NYU Grossman School of Medicine, New York, New York.
Division of Neonatology, Departments of Pediatrics and Molecular Medicine, University of South Florida, Tampa, Florida.
Am J Perinatol. 2022 Oct;39(13):1441-1448. doi: 10.1055/s-0040-1722653. Epub 2021 Jan 21.
The study aimed to evaluate the effects of inhaled iloprost on oxygenation indices in neonates with persistent pulmonary hypertension of the newborn (PPHN).
We conducted a retrospective chart review of 30 patients with PPHN from January 2014 to November 2018, who did not respond to inhaled nitric oxide (iNO) alone and received inhaled iloprost. Twenty-two patients met the inclusion criteria and eight patients were excluded from the study (complex cardiac disease and extreme prematurity). Patients were categorized as responders or nonresponders (patients who required extracorporeal membrane oxygenation or died). Oxygenation index, mean airway pressure (MAP), and arterial partial pressure of oxygen (PaO) were recorded.
Among a total of 22 patients who were included in the study, 10 were classified as nonresponders as they required either extracorporeal membrane oxygenation or died. Gestational age and gender did not differ between responders and nonresponders. The median PaO was lower (37 vs. 42 mm Hg; < 0.05) and median MAP was higher (20 vs. 17 cm HO; < 0.02) in nonresponders compared with responders just prior to initiating iloprost. Iloprost responders had a significant increase in median PaO and decrease in median oxygenation index in the 24 hours after initiating treatment ( < 0.05), with no significant change in required mean airway pressure over that same period. There was no change in vasopressor use or clinically significant worsening of platelets count, liver, and kidney functions after initiating iloprost.
Inhaled iloprost is well tolerated and seems to have beneficial effects in improving oxygenation indices in neonates with PPHN who do not respond to iNO. There is a need of well-designed prospective trials to further ascertain the benefits of using inhaled iloprost as an adjunct treatment in neonates with PPHN who do not respond to iNO alone.
· Inhaled iloprost seems to have beneficial effects in improving oxygenation indices in PPHN.. · Inhaled iloprost is generally well tolerated in newborns with PPHN.. · There is a need for prospective randomized controlled trials to further ascertain the benefits of using inhaled iloprost..
本研究旨在评估吸入伊洛前列素对新生儿持续性肺动脉高压（PPHN）患者氧合指数的影响。
我们对 2014 年 1 月至 2018 年 11 月期间因单独吸入一氧化氮（iNO）治疗无效而接受吸入伊洛前列素治疗的 30 例 PPHN 患者进行了回顾性图表审查。22 例患者符合纳入标准，8 例患者被排除（复杂心脏病和极早产儿）。将患者分为应答者和无应答者（需要体外膜氧合或死亡的患者）。记录氧合指数、平均气道压（MAP）和动脉血氧分压（PaO2）。
在总共纳入研究的 22 例患者中，有 10 例因需要体外膜氧合或死亡而被归类为无应答者。应答者和无应答者的胎龄和性别无差异。在开始使用伊洛前列素之前，无应答者的中位 PaO2 较低（37 对 42 mmHg； < 0.05），MAP 较高（20 对 17 cm H2O； < 0.02）。与治疗开始前相比，伊洛前列素应答者在治疗开始后 24 小时内中位 PaO2 显著升高，中位氧合指数显著降低（ < 0.05），而同期平均气道压无显著变化。开始使用伊洛前列素后，血管加压药的使用或血小板计数、肝肾功能的临床显著恶化均无变化。
吸入伊洛前列素耐受性良好，似乎可改善对 iNO 治疗无反应的新生儿 PPHN 的氧合指数。需要进行精心设计的前瞻性试验，以进一步确定吸入伊洛前列素作为对 iNO 单独治疗无反应的新生儿 PPHN 的辅助治疗的益处。
·吸入伊洛前列素似乎可改善对 iNO 治疗无反应的 PPHN 患者的氧合指数。·吸入伊洛前列素在新生儿 PPHN 中通常耐受性良好。·需要前瞻性随机对照试验来进一步确定吸入伊洛前列素的益处。
