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Title of the item:

1406 INTRAVENOUS NITROGLYCERIN (NTG) IN THE TREATMENT OF PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN (PPHN)

Title:
1406 INTRAVENOUS NITROGLYCERIN (NTG) IN THE TREATMENT OF PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN (PPHN)
Authors:
Hageman, Joseph R
Farrell, Elaine E
Source:
Pediatric Research; April 1985, Vol. 19 Issue: 4 p345A-345A, 1p
Periodical
We report the use of intravenous NTG in a 2600 gram, 37-week gestational age newborn with PPHN unresponsive to hyperventilation(HV). The diagnosis of PPHN was made based on unexplained hypoxemia, initial positive response to HV, and evidence of a ductal level right-to-left shunt. After repeated transient responses to HV and pancuronium therapy, the PaO2/FiO2dropped to 53. An IV continuous infusion of NTG was begun at 5.9 mcg/kg/ min. at 45 hours of age. The infusion was increased in a step-wise manner to 13 mcg/kg/min. After each increase, a transient elevation in PaO2/FiO2occurred. After the increase to 13 mcg/kg/min., and without any alteration in ventilatory settings, a sustained rise in PaO2/FiO2to 242 was noted. No significant changes in CVP (5-6 cm H2O) or arterial blood pressure(mean= 54-59 mm Hg) pre- or post-NTG were seen. NTG was stopped by Day 4, pancuronium and HV by Day 5, and assisted ventilation by Day 9. He was discharged home on Day 19. Twelve month follow-up is normal.Intravenous nitroglycerin may be as effective a pulmonary vasodilator in the treatment of neonates with PPHN and may be used with significantly less side effects than seen with tolazoline. Further clinical trials will be necessary to establish its efficacy.

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