title: Adenosine infusion for the management of persistent pulmonary hypertension of the newborn.
abstract: OBJECTIVE
  To determine the effect of adenosine for the management of persistent pulmonary hypertension of the newborn.
  
  
  METHODS
  Prospective, observational case series report.
  
  
  METHODS
  A single, tertiary referral neonatal intensive care unit.
  
  
  METHODS
  Nine neonates with persistent pulmonary hypertension of the newborn requiring mechanical ventilation and inhaled nitric oxide at 20 parts per million.
  
  
  METHODS
  A continuous intravenous infusion of adenosine at 50 microg/kg/min.
  
  
  RESULTS
  Peripheral arterial oxygen saturation, arterial oxygen tension, invasive systemic arterial blood pressure, and pulmonary arterial pressure, estimated using echocardiography, were recorded. There was a significant improvement in arterial oxygenation tension in six of nine neonates who responded to adenosine: PaO2 increased from 66.8 (range, 47-70.5) torr (8.8 kPa) to 73.5 (range, 58.5-94.2) (p=.02) and pulmonary arterial pressure decreased significantly from 63 (range, 42.5-64.0) to 43.5 (range, 32.75-49) mm Hg (p=.002). The pulmonary to systemic mean artery pressure ratio fell from 1.27 (range, 0.88-1.5) to 0.81 (range, 0.64-0.84) (p=.002). Three neonates did not respond to adenosine infusion.
  
  
  CONCLUSIONS
  The use of adenosine infusion in combination with inhaled nitric oxide may be a potentially valuable therapeutic option for the treatment of pulmonary hypertension of the newborn. Neonates with irreversible lung pathology may not respond to adenosine infusion.
authors.affiliation: Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK.
authors.forename: Cho
authors.initials: C
authors.lastname: Ng
authors.forename: Orla
authors.initials: O
authors.lastname: Franklin
authors.forename: Mamta
authors.initials: M
authors.lastname: Vaidya
authors.forename: Christine
authors.initials: C
authors.lastname: Pierce
authors.forename: Andy
authors.initials: A
authors.lastname: Petros
mesh_terms: D000241:Adenosine / Q000627:therapeutic use*; D000280:Administration, Inhalation; D004359:Drug Therapy, Combination; D006801:Humans; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D009569:Nitric Oxide / Q000627:therapeutic use; D010547:Persistent Fetal Circulation Syndrome / Q000188:drug therapy*; D011446:Prospective Studies; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D009569:Nitric Oxide; D000241:Adenosine