MAGNESIUM-SULFATE AS AN ALTERNATIVE AND SAFE TREATMENT FOR SEVERE PERSISTENT PULMONARY-HYPERTENSION OF THE NEWBORN

Eleven newborns admitted consecutively to the neonatal unit with respi ratory failure and severe persistent pulmonary hypertension (PPHN) wer e included in a clinical trial to assess the efficacy of magnesium sul phate (MgSO4) in the treatment of PPHN. A loading dose of 200 mg/kg Mg SO4 was given over 20 minutes, followed by a continuous infusion of 20 -150 mg/kg/hour to obtain a magnesium blood concentration between 3.5 and 5.5 mmol/l. Mean (SD) duration of treatment was 75.5 (19.8) hours. No other vasodilatory drug was administered before or during the trea tment and patients were not hyperventilated. Mean (SEM) PaO2 values si gnificantly increased from 42.6 (8.8) before treatment to 70.3 (24.1) mm Hg after 24 hours, with no change in pH or PCO2. Oxygen index and a lveolar-arterial oxygen gradient (A-aDo(2)) were significantly lower a fter 24 hours; respectively, 46.8 (15.2) to 28.0 (9.0) and 624.3 (11.3 ) to 590 (58) mm Hg. Mean airway pressure could be significantly reduc ed from 19.5 (3.1) to 13.9 (3.9) cm H2O after 72 hours. Mean ventilato ry time support was 131 hours and mean total oxygen dependency 10 days . No systemic hypotension nor any other adverse effect were noted. Ah infants survived and the neurodevelopmental assessment was normal at 6 and 12 months of age. It is concluded that magnesium sulphate is a no n-aggressive and low-cost treatment of short duration which is easy to apply. It may have a role in the various treatment of PPHN.