Intravenous iloprost may be an effective first-line treatment for persistent pulmonary hypertension of the newborn in limited-resource situations

Abstract

Background: Persistent pulmonary hypertension of the newborn (PPHN) is one of the most serious conditionsin neonates, and has high mortality and morbidity rates. New alternative therapies have been sought forimproving survival and reducing morbidity for PPHN. Objective: To report an initial experience of using intravenous iloprost to treat infants with PPHN, and assessits effect on oxygenation and hemodynamic stability over a 96-hour study. Methods: The clinical data of infants who received intravenous iloprost as first line adjunctive therapy forPPHN at our institution between March 2009 and June 2010 were retrospectively reviewed. Results: During the study period, 10 PPHN infants received intravenous iloprost as the first line of adjunctivetherapy. The median gestational age was 40 weeks (range: 38-42), and birth weight was 3,250 grams (range:2,310-3,900 g). Intravenous iloprost was initiated at an average age of 38 ± 26 hours (median: 32 h, range: 6-79 h),with an average baseline oxygen index (OI) of 25 ± 18 (median: 18, range: 8-65). Two infants who died whilereceiving the intravenous iloprost were excluded from our analysis because of incomplete data. Of the 8 whosurvived, the baseline OI was 24 ± 20 (median: 17, range: 8-65), and the mean OIs at 24 and 72 hours followingtreatment were significantly improved (16 ± 18 (median: 6, range: 4-50) (p = 0.02), and 9 ± 5 (median: 8, range:3-18) (p = 0.02), respectively). No clinically significant changes in heart rate or blood pressure were noted duringthe iloprost therapy. At discharge, 6 of the infants were clinically normal, and 2 were complicated with cholestaticjaundice. No neurodevelopmental or cardiopulmonary disorders were observed in the 8 surviving infants athospital discharge or later follow-up visits. Conclusion: Intravenous iloprost may be a useful adjunctive therapy in PPHN, and should be investigated in alarger controlled study. Keywords: Iloprost, newborn infant, neonatal mortality, persistent pulmonary hypertension of the newborn