Magnesium sulphate as an alternative and safe treatment for severe persistent pulmonary hypertension of the newborn.

Abstract

Eleven newborns admitted consecutively to the neonatal unit with respiratory failure and severe persistent pulmonary hypertension (PPHN) were included in a clinical trial to assess the efficacy of magnesium sulphate (MgSO4) in the treatment of PPHN. A loading dose of 200 mg/kg MgSO4 was given over 20 minutes, followed by a continuous infusion of 20-150 mg/kg/hour to obtain a magnesium blood concentration between 3 5 and 5 5 mmol/l. Mean (SD) duration of treatment was 75-5 (19.8) hours. No other vasodilatory drug was administered before or during the treatment and patients were not hyperventilated. Mean (SEM) PaO2 values significantly increased from 42-6 (8.8) before treatment to 70*3 (24.1) mm Hg after 24 hours, with no change in pH or Pco2. Oxygen index and alveolar-arterial oxygen gradient (A-aDo2) were significantly lower after 24 hours; respectively, 46-8 (15.2) to 28-0 (9.0) and 624-3 (11-3) to 590 (58) nmn Hg. Mean airway pressure could be significantly reduced from 19*5 (3-1) to 13-9

Randomized controlled trial of magnesium sulfate in women at risk of preterm delivery—neonatal cardiovascular effects

“…10,11 Small case series have reported an apparent benefit from use of postnatal MgSO 4 for persistent pulmonary hypertension of the newborn. [12][13][14][15] In the first day after birth, when shunts frequently occur across the adapting heart, cardiac input (superior vena cava (SVC) flow) as a measure of systemic blood flow has been reproducibly reported to predict organ injury and neonatal outcome. [16][17][18] Low systemic blood flow in the first day has been associated with the development of late peri/intraventricular hemorrhage (PIVH), 16 subsequent developmental impairment 17,18 and abnormal motor outcome 18 up to 3 years corrected age.…”

Pharmacotherapy for meconium aspiration

“…55,56 However, in clinical trials in children who have failed conventional therapies, significant improvement has been shown in both oxygenation and oxygenation index without significant hypotension. 16,56 Magnesium sulfate also has sedative and antithrombotic activities. In third world countries where INO is not easily available, this multifaceted drug can be used to alleviate hypoxia.…”

Severe transient neonatal lactic acidosis during prophylactic zidovudine treatment

“…There was progressive onset of severe respiratory distress due to persistent fetal circulation (PFC) diagnosed on the basis of refractory hypoxemia (fractional inspired oxygen 1.0, arterial oxygen tension 39 mm Hg, arterial-alveolar 02 tension ratio 0.06) with normal chest X-ray, absence of congenital heart disease and s suprasystemic pulmonary pressure on echo Doppler. Treatment included intubation and mechanical ventilation with morphine sedation, correction of anaemia (haemoglobin a All day 9 values were collected 2 h prior to reintubation 103 g/l, mean corpuscular volume 117 fl), inotropic support, alkalinization by hyperventilation and bicarbonate administration, and continuous intravenous magnesium therapy [3]. Ampicillin was given from days 1 to 10.…”