Pharmacologic strategies in neonatal pulmonary hypertension other than nitric oxide

Satyanarayana Lakshminrusimha, Bobby Mathew, Corinne L. Leach

Research output: Contribution to journalReview article

32 Scopus citations

Abstract

Inhaled nitric oxide (iNO) is approved for use in persistent pulmonary hypertension of the newborn (PPHN) but does not lead to sustained improvement in oxygenation in one-third of patients with PPHN. Inhaled NO is less effective in the management of PPHN secondary to congenital diaphragmatic hernia (CDH), extreme prematurity, and bronchopulmonary dysplasia (BPD). Intravenous pulmonary vasodilators such as prostacyclin, alprostadil, sildenafil, and milrinone have been successfully used in PPHN resistant to iNO. Oral pulmonary vasodilators such as endothelin receptor antagonist bosentan and phosphodiesterase-5 inhibitors such as sildenafil and tadalafil are used both during acute and chronic phases of PPHN. In the absence of infection, glucocorticoids may also be effective in PPHN. Many of these pharmacologic agents are not approved for use in PPHN and our knowledge is based on case reports and small trials. Large multicenter randomized controlled trials with long-term follow-up are required to evaluate alternate pharmacologic strategies in PPHN.

Original languageEnglish (US)
Article number50885
Pages (from-to)160-173
Number of pages14
JournalSeminars in Perinatology
Volume40
Issue number3
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

Keywords

  • Bosentan
  • Hypoxia
  • Iloprost
  • Milrinone
  • Nitric oxide
  • Oxygen
  • Prostacyclin
  • Sildenafil

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

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