Pharmacologic strategies in neonatal pulmonary hypertension other than nitric oxide

Seminars in Perinatology
S LakshminrusimhaCorinne L Leach

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.

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Citations

Jan 1, 2017·Physiological Reports·Mohamed AhmedYousef Al-Abed
Aug 10, 2017·Children·Bobby Mathew, Satyan Lakshminrusimha
Dec 7, 2017·Maternal Health, Neonatology and Perinatology·Satyan LakshminrusimhaRosemary D Higgins
Jan 29, 2017·Journal of Perinatal Medicine·Christiana Farkouh-KaroleskiHoward Needelman
Jun 16, 2018·Pediatric Pulmonology·Daniela MokraKatarina Matasova
Jun 2, 2018·Basic & Clinical Pharmacology & Toxicology·Jonas PedersenDaniela Grimm
Jun 29, 2018·American Journal of Physiology. Lung Cellular and Molecular Physiology·Nelida OlaveNamasivayam Ambalavanan
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Sep 12, 2020·Physiological Reports·Julie DillardBernadette Chen
Dec 25, 2019·Pediatric Allergy, Immunology, and Pulmonology·Nidhy Varghese, Danielle Rios
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Sep 9, 2021·Jornal brasileiro de pneumologia : publicaça̋o oficial da Sociedade Brasileira de Pneumologia e Tisilogia·Mário Cícero FalcãoJuliana Zoboli Del Bigio
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Dec 26, 2021·Archives of Disease in Childhood. Fetal and Neonatal Edition·Felix R De BieNatalie E Rintoul

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