Adenosine infusion for the management of persistent pulmonary hypertension of the newborn.
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.
Ng
Cho
C
Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK.
Franklin
Orla
O
Vaidya
Mamta
M
Pierce
Christine
C
Petros
Andy
A
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*
D014665:Vasodilator Agents; D009569:Nitric Oxide; D000241:Adenosine