PROSTACYCLIN TREATMENT FOR PERSISTENT PULMONARY-HYPERTENSION OF THE NEWBORN

To study the effect of prostacyclin treatment on pulmonary arterial pr essure (PAP), systolic pressure (BP), and systemic oxygenation, eight infants with per sistent pulmonary hypertension of the newborn (PPHN) born between 34 and 42 weeks' gestation and having a birth weight of 2 540-4130 g were studied using Doppler echocardiography. At a mean age of 19 hours (range 3-32 hours), despite maximal ventilator therapy and an FIO2 of 1.0, the mean PaO2/PAO(2) was 0.07 (range 0.04-0.09) and t he AaDO(2) was 616 mmHg (range 521-654 mmHg). After volume correction and during inotropic medication with dopamine and dobutamine, the mean PAP by echocardiography was 68.6 +/- 6.5 mmHg and the mean BP 59.8 +/ - 4.8 mmHg. Prostacyclin infusion was then started at a dose of 20 ng/ kg/min and increased stepwise to a mean dose of 60 ng/kg/min (range 30 -120 ng/kg/min) over 4-12 hours, at which time PAP decreased to 49.2 /- 3.5 mmHg (p = 0.0005) and BP to 53.2 +/- 9.1 mmHg (p = 0.17); the P AP thereafter remained below the BP. After 72 hours of prostacyclin in fusion, PAP was 49.6 +/- 18 mmHg, BP 66.1 +/- 5.4 mmHg, PaO2/PAO(2) 0. 14 +/- 0.12, and AaDO(2) 428 +/- 189 mmHg at FIO2 0.65. The median dur ation of prostacyclin infusion was 3.6 days and of respirator treatmen t 7.0 days. All patients survived without extracorporeal membrane oxyg enation, At 6-12 months, none of the patients had severe central nervo us system complications, but two had bronchopulmonary dysplasia. These findings indicate that prostacyclin is able to reverse the right-to-l eft shunt in PPHN by decreasing PAP, and that systemic hypotension can be prevented with adequate volume cor rection and inotropic medicatio n.