title: Pharmacologic strategies in neonatal pulmonary hypertension other than nitric oxide.
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.
authors.affiliation: Department of Pediatrics, University at Buffalo, Buffalo, NY. Electronic address: slakshmi@buffalo.edu.
authors.forename: Satyan
authors.initials: S
authors.lastname: Lakshminrusimha
authors.affiliation: Department of Pediatrics, University at Buffalo, Buffalo, NY.
authors.forename: Bobby
authors.initials: B
authors.lastname: Mathew
authors.affiliation: Department of Pediatrics, University at Buffalo, Buffalo, NY.
authors.forename: Corinne L
authors.initials: CL
authors.lastname: Leach
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000150:complications; D004333:Drug Administration Routes; D065630:Hernias, Diaphragmatic, Congenital / Q000150:complications; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D009569:Nitric Oxide / Q000008:administration & dosage / Q000009:adverse effects; D010547:Persistent Fetal Circulation Syndrome / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000145:classification / Q000494:pharmacology
chemical_list: D014665:Vasodilator Agents; D009569:Nitric Oxide
keywords: Bosentan; Hypoxia; Iloprost; Milrinone; Nitric oxide; Oxygen; Prostacyclin; Sildenafil