Continuous inhaled iloprost in a neonate with <scp>d</scp>-transposition of the great arteries and severe pulmonary arterial hypertension

Dykes, J.C.; Torres, Marilyn; Alexander, Plato

doi:10.1017/s1047951115001250

Cited by 4 publications

(24 citation statements)

References 6 publications

(21 reference statements)

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“…Although there are no randomized control trials for the use of prostanoids or their analogues as pulmonary vasodilators and sole therapeutic agents for the treatment of PPHN in neonates (age 28 days or less) (8), this report, along with others suggest that inhaled iloprost, single or combined, is useful and effective in neonates with PPHN. It is readily available and has comparable clinical effects to iNO (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32).…”

Section: Discussionmentioning

confidence: 99%

“…Nonetheless, there are no safety and efficacy data in children (36). For neonates, multiple different dosage are used in the literature; 0.2-2.5 mcg/kg/dose, every 1-6 hours in general (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Continuous inhalation is also reported (30).…”

Section: Discussionmentioning

confidence: 99%

“…For neonates, multiple different dosage are used in the literature; 0.2-2.5 mcg/kg/dose, every 1-6 hours in general (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Continuous inhalation is also reported (30). Delivering one dose of inhalation lasts approximately 5 minutes , and the clinical effect at the start of the therapy last 1-2 hours at most in our experience.…”

Section: Discussionmentioning

confidence: 99%

“…Iloprost is an analogue of prostacyclin with greater chemical stability (16). There are a number of reports which have addressed the use of inhaled iloprost inhalation therapy for pulmonary hypertension of the newborn in the literature (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). 1-2 mcg/kg/dose, every 1-4 hours is the most used dose.…”

Section: Introductionmentioning

confidence: 99%

“…1-2 mcg/kg/dose, every 1-4 hours is the most used dose. Dykes et al, suggested a continuous inhalation (5 mcg/hour) to avoid swings in haemodynamics in a in a neonate with d-transposition of the great arteries and severe PAH (30).…”

Section: Introductionmentioning

confidence: 99%

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Inhaled iloprost is an effective alternative therapy for persistent pulmonary hypertension of the newborn

Yıldırım¹

2022

Preprint

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Purpose: Persistent pulmonary hypertension of the newborn (PPHN) is a disease with potential serious morbidity and mortality. Inhaled iloprost, a stable analogue of prostacyclin, has recently been used as a therapeutic option. However, there are no clinical guidelines on the use of iloprost, specifically for neonates. This study aimed to suggest the use of inhaled iloprost as a rescue therapy for PPHN based on our experience. Methods: This was a retrospective study. The data from medical records of 6 newborns (4 late preterm, 2 term), diagnosed as persistent pulmonary hypertension of the newborn and had received inhaled iloprost from December 2019 to November 2021 were collected. Demographic and clinical features, changes in PaO , FiO , oxygenization index, echocardiographic findings and mortality were evaluated. Results: The inhalation dose was 2 mcg/dose, and 1-48 inhalations per day were applied over 4-9 days. Inhaled iloprost was as effective as iNO in all the patients. No side effects attributable to inhaled iloprost and no mortality was recorded. Conclusion: Our experience suggests that inhaled iloprost can be used as a first-line therapy in newborn infants with PPHN when inhaled nitric oxide is not available.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Inhaled iloprost is an effective alternative therapy for persistent pulmonary hypertension of the newborn

Yıldırım¹

2022

Preprint

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Inhaled iloprost is an effective alternative therapy for persistent pulmonary hypertension in newborns

Yıldırım

2023

Pulm. circ.

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Persistent pulmonary hypertension of the newborn (PPHN) is one of the diseases of the neonate with severe potential morbidity and mortality. Inhaled iloprost, a stable prostacyclin analog, has been suggested as an alternative treatment for inhaled nitric oxide (iNO). However, more data on neonates' dosing, setting, and effectiveness still needs to be solved. This study suggests using inhaled iloprost as rescue therapy for PPHN based on our experience. This was a retrospective study. The data from medical records of six newborns diagnosed with PPHN and had received inhaled iloprost from December 2019 to April 2022 were collected. Demographic and clinical features, dosing regimen, changes in oxygenation index, echocardiographic findings, and mortality were evaluated. The inhalation dose was 2−4 mcg/dose, and 3−48 inhalations per day were applied over 2−7 days. Inhaled iloprost was effective in all patients. No side effects were attributable to inhaled iloprost, and no mortality was recorded. Our experience suggests that inhaled iloprost can be used as a first‐line therapy in newborn infants with PPHN when iNO is unavailable. However, there are large fluctuations in the oxygenation index due to the setting.

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Safety and tolerability of continuous inhaled iloprost in critically ill pediatric pulmonary hypertension patients: A retrospective case series

Colglazier,

Ng,

Parker

et al. 2023

Pulm. circ.

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Inhaled iloprost (iILO) has shown efficacy in treating patients with hypoxic lung disease and pulmonary hypertension, inducing selective pulmonary vasodilation and improvement in oxygenation. However, its short elimination half‐life of 20–30 min necessitates frequent intermittent dosing (6–9 times per day). Thus, the administration of iILO via continuous nebulization represents an appealing method of drug delivery in the hospital setting. The objectives are: (1) describe our continuous iILO delivery methodology and safety profile in mechanically ventilated pediatric pulmonary hypertension patients; and (2) characterize the initial response of iILO in these pediatric patients currently receiving iNO. Continuous iILO was delivered and well tolerated (median 6 days; range 1–94) via tracheostomy or endotracheal tube using the Aerogen® mesh nebulizer system coupled with a Medfusion® 400 syringe pump. No adverse events or delivery malfunctions were reported. Initiation of iILO resulted in an increase in oxygen saturation from 81.4 ± 8.6 to 90.8 ± 4.1%, p < 0.05. Interestingly, prior iNO therapy for >1 day resulted in a higher response rate to iILO (as defined as a ≥ 4% increase in saturations) compared to those receiving iNO <1 day (85% vs. 50%, p = 0.06). When the use of iILO is considered, continuous delivery represents a safe, less laborious alternative and concurrent treatment with iNO should not be considered a contraindication. However, given the retrospective design and small sample size, this study does not allow the evaluation of the efficacy of continuous iILO on outcomes beyond the initial response. Thus, a prospective study designed to evaluate the efficacy of continuous iILO is necessary.

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Continuous inhaled iloprost in a neonate with d-transposition of the great arteries and severe pulmonary arterial hypertension

Cited by 4 publications

References 6 publications

Inhaled iloprost is an effective alternative therapy for persistent pulmonary hypertension of the newborn

Inhaled iloprost is an effective alternative therapy for persistent pulmonary hypertension of the newborn

Inhaled iloprost is an effective alternative therapy for persistent pulmonary hypertension in newborns

Safety and tolerability of continuous inhaled iloprost in critically ill pediatric pulmonary hypertension patients: A retrospective case series

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