Farag Marwa Mohammed, Ghazal Hesham Abd El-Rahim, Abdel-Mohsen Aly Mohamed, Rezk Moataz Ahmed
Pediatric Department, Alexandria University Hospital, Alexandria, Egypt.
Eur J Pediatr. 2025 Sep 1;184(9):586. doi: 10.1007/s00431-025-06381-5.
The objective was to evaluate the effect of nebulized nitroglycerin (NNG) in neonates with persistent pulmonary hypertension (PPHN). The study focused on assessing changes in echocardiographic and clinical parameters following its administration. This is a randomized controlled trial that included 80 full-term newborns diagnosed with PPHN within 72 h after birth. Participants were randomized into two groups: the NNG group received nebulized nitroglycerin, while the control group did not receive it as adjunctive therapy to PPHN. Clinical parameters and echocardiographic measures were evaluated before intervention, and subsequently at 24 and 48 h. The primary outcome was the estimated systolic pulmonary artery pressure in both groups. Comparative analyses were conducted between the groups, along with repeated measures within each group. The NNG group exhibited a significant improvement in the oxygenation index and oxygen saturation index (OI&OSI) on days 2 and 3. There was a marked reduction in the systolic pulmonary artery pressure/systolic systemic pressure (SPAP/SSP) ratio, accompanied by a significant enhancement in biventricular systolic function and cardiac output. The myocardial performance index (MPI), as measured by tissue-Doppler echocardiography, was notably decreased in the NNG group on day 3. Furthermore, the requirements for ventilatory support and inotropic agents were significantly lower in the NNG group. Survival analysis indicated a more favorable weaning course in the NNG group.Conclusion: NNG was effective in managing neonates with PPHN and might be a promising, alternative therapy for PPHN, especially in settings where inhaled nitric oxide is unavailable.Trial registration: Clinical-Trial.gov identifier: NCT05741229 and was registered on February 14, 2023. URL: https://clinicaltrials.gov/study/NCT05741229 .
目的是评估雾化硝酸甘油（NNG）对持续性肺动脉高压（PPHN）新生儿的疗效。该研究重点评估给药后超声心动图和临床参数的变化。这是一项随机对照试验，纳入了80例出生后72小时内诊断为PPHN的足月儿。参与者被随机分为两组：NNG组接受雾化硝酸甘油治疗，而对照组不接受，作为PPHN的辅助治疗。在干预前、随后的24小时和48小时评估临床参数和超声心动图测量值。主要结局是两组的估计收缩期肺动脉压。对两组进行了比较分析，并在每组内进行了重复测量。NNG组在第2天和第3天的氧合指数和氧饱和度指数（OI&OSI）有显著改善。收缩期肺动脉压/收缩期体循环压（SPAP/SSP）比值显著降低，同时双心室收缩功能和心输出量显著增强。通过组织多普勒超声心动图测量的心肌性能指数（MPI）在NNG组第3天显著降低。此外，NNG组对通气支持和强心剂的需求显著更低。生存分析表明NNG组的撤机过程更有利。结论：NNG对治疗PPHN新生儿有效，可能是PPHN一种有前景的替代疗法，尤其是在无法获得吸入一氧化氮的情况下。试验注册：Clinical-Trial.gov标识符：NCT05741229，于2023年2月14日注册。网址：https://clinicaltrials.gov/study/NCT05741229 。
