The systemic and myocardial cffects of adenosine and ATP were investigated in 12 newborn lambs, instrumented at 5-7 d of age with catheters in the aorta, pulmonary artery, coronary sinus, and right and left atria and flow transducers around the main pulmonary artery and lcft circumflex coronary artery. Studies were done 3-7 d after recovery from surgery. Pulmonary hypertension was induced by exposure to alveolar hypoxia (10%-O,, 5%) CO,, and 85% N,), which was maintained throughout the experiment. Adenosine, ATP, or an equal volume of saline (control) was infused into the right atrial line in doses of 0.04 to 2.5 pmol/kg/min during hypoxia. Alveolar hypoxia caused significant increases in pulmonary artery pressure, pulmonary vascular resistance, left circumflex flow, left ventricular 0, consumption, and systemic and myocardial 0, extraction and a dccrcasc in systemic 0, transport. ATP and adenosine caused selective decreases in pulmonary artery pressure and pulmonary vascular resistance at doses of 0.04 to 0.30 pmol/kg/min and decreases in both pulmonary and systemic pressures and resistances at 0.60 to 2.5 pmol/kg/min. ATP and adenosine caused increases in systemic 0, transport, left circumflex flow, left ventricular 0, transport, and lcft ventricular 0, consumption and dccreases in systemic 0, extraction and left ventricular 0, extraction at 0.3 to 2.5 pmol/kg/min. Systemic 0, consumption did not change during thc study. Arterial and coronary sinus blood lactate levels increased during hypoxia and decreased from hypoxia at 2.5-pmol/kg/min infusion rates of adenosine and ATP. Adenosine and ATP cause selective pulmonary vasodilation in lambs with pulmonary hypertension at doses of 0. Persistent pulmonary hypertension of the newborn is a hypotension and tachycardia a s side effects (2). The incondition associated with high morbidity and mortality. crease in heart rate and systemic vasodilation results in The affected infants have an increased PVR and hypox-increases in VO, and MVO, during hypoxia (3). Newborn emia secondary t o right-to-left shunting of blood across infants have a high resting cardiac output and 0, confetal channels (I). Vasodilator drugs that are used in the sumption (4) and are limited in their ability t o augment management of this condition, such a s tolazoline, Seem to S O T during hypoxia ( 5 ) . Therefore, an increase in 0, dilate both pulmonary and systemic vessels and cause consumption during vasodilator therapy may cornpromise tissue oxygenation in hypoxic infants.Adenosine and ATP are purine nucleotides that dilate cleared during a single pass through the lung (8) when 42 KONDURI they are infused in low doses into the right atrium. ATP infusion causes selective pulmonary vasodilation in doses 5 0.15 pmol/kg/min in newborn lambs with pulmonary hypertension induced by alveolar hypoxia (9) or infusion of thromboxane mimetic U46hl9 (10) and in newborn piglets (11) during hypoxia. ATP has been shown to cause selective pulmonary vasodilation at doses 5 0.15 pmol/kg/min in children with conge...