title: Nebulized iloprost and noninvasive respiratory support for impending hypoxaemic respiratory failure in formerly preterm infants: a case series.
abstract: OBJECTIVE
  To describe a series of ex-preterm infants admitted to pediatric intensive care unit due to impending hypoxaemic respiratory failure complicated by pulmonary hypertension (PH) who were treated electively combining noninvasive ventilation (NIV) and nebulized iloprost (nebILO).
  
  
  METHODS
  Open uncontrolled observational study.
  
  
  METHODS
  Pediatric Intensive Care Unit, University Hospital.
  
  
  METHODS
  Ten formerly preterm infants with impending hypoxaemic respiratory failure and PH, of whom eight had moderate to severe bronchopulmonary dysplasia.
  
  
  RESULTS
  Median age and body weight were 6.0 (2.75-9.50) months and 4.85 (3.32-7.07) kg, respectively. We observed a significant early oxygenation improvement in terms of PaO(2) /FiO(2) increase (P = 0.001) and respiratory rate reduction (P = 0.01). Hemodynamic also improved, as shown by heart rate (P = 0.002) and pulmonary arterial pressure systolic/systolic systemic pressure (PAPs/SSP) ratio reduction (P = 0.0137). NebILO was successfully weaned in positive response cases: 4 infants were discharged on oral sildenafil. Three patients failed noninvasive modality and needed invasive mechanical ventilation; hypoxic-hypercarbic patients were most likely to fail noninvasive approach. Only one patient requiring invasive ventilation died and surviving babies had a satisfactory 1-month post-discharge follow-up. CONCLUSIONS.: The noninvasive approach combining NIV and nebILO for ex-preterm babies with impending respiratory failure and PH resulted to be feasible and quickly achieved significant oxygenation and hemodynamic improvements.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Paediatric Intensive Care Unit, University Hospital A Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Piastra
authors.forename: Daniele
authors.initials: D
authors.lastname: De Luca
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: De Carolis
authors.forename: Alessia
authors.initials: A
authors.lastname: Tempera
authors.forename: Eleonora
authors.initials: E
authors.lastname: Stival
authors.forename: Francesca
authors.initials: F
authors.lastname: Caliandro
authors.forename: Domenico
authors.initials: D
authors.lastname: Pietrini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Conti
authors.forename: Gabriella
authors.initials: G
authors.lastname: De Rosa
mesh_terms: D000280:Administration, Inhalation; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000628:therapy*; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D016285:Iloprost / Q000008:administration & dosage*; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods*; D012131:Respiratory Insufficiency / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D014665:Vasodilator Agents; D016285:Iloprost