Aerosolized iloprost in the treatment of pulmonary hypertension in extremely preterm infants: a pilot study.
BACKGROUND
In premature infants with preterm prolonged rupture of membranes, death after birth is often due to persistent pulmonary hyper-tension.


METHODS
Aerosolized iloprost was used to treat pulmonary hypertension due to prolonged preterm rupture of fetal membranes (7-56 days) in four extremely low-birthweight neonates (23-25 weeks' gestation, weight 448-645 g) under spontaneous breathing supported by nasal continuous positive airway pressure.


METHODS
Inhalation dose was 2 microg/kg b.w. and between 44 and 65 inhalations were performed in each patient starting within the first hour of life over a total of several days. Single inhalations lasted 5 min and were not repeated until 60 min had elapsed.


RESULTS
After the first inhalation, the PaO2/FiO2 mean ratio increased from 65 (range 35-114) to 194 (148-250) mmHg and oxygenation requirements decreased within the next 7 days. Echocardiography similarly showed reduction in pulmonary resistance. We observed no severe side effects on blood pressure or prolonged bleeding time during inhalation.


CONCLUSIONS
Iloprost inhalation might therefore be an additional treatment for improving oxygenation in cases of persistent pulmonary hypertension in extremely low-birthweight infants under spontaneous breathing. Further randomized clinical studies are required to establish the role of iloprost in this setting.
Eifinger
F
F
Klinik und Poliklinik für Kinderheilkunde, Abteilung für Neonatologie, Klinikum der Universität zu Köln. frank.eifinger@uk-koeln.de
Sreeram
N
N
Mehler
K
K
Huenseler
C
C
Kribs
A
A
Roth
B
B
D000336:Aerosols; D000367:Age Factors; D045422:Continuous Positive Airway Pressure; D016638:Critical Illness; D004452:Echocardiography; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D005865:Gestational Age; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D016285:Iloprost / Q000008:administration & dosage*; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000188:drug therapy*; D008297:Male; D010865:Pilot Projects; D011247:Pregnancy; D012138:Respiratory Therapy; D013997:Time Factors; D014665:Vasodilator Agents / Q000008:administration & dosage*
D000336:Aerosols; D014665:Vasodilator Agents; D016285:Iloprost