Pulmonary hypertension neonatal

Bindl L, Fahnenstich H, Peukert U. Aerosolised prostacyclin for pulmonary hypertension in neonates. Arch Dis Child Fetal Neonatal Ed 1994 71(3) F214-6. 

Arevalo RP, Bullabh P, Krauss AN, Auld PAM, Spigland N. Octreotide-induced hypoxemia and pulmonary hypertension in premature neonates. J Pediatr Surg 2003 38 251-3. 

Tang, J. R., Markham, N. E., Lin, Y. J., McMurtry, I. F., Maxey, A., et al. 2004. Inhaled nitric oxide attenuates pulmonary hypertension and improves lung growth in infant rats after neonatal treatment with a VEGF receptor inhibitor. Am. J. Physiol. Lung Cell Mol. Physiol. 287 L344— L351. 

Indications Pulmonary hypertension in the newborn Category Sulfonylurea Half-life 3-10 hours (neonates)... 

Despite the high success rates, 20% of neonates fail to respond to treatment. Factors associated with poor response inclnde sepsis, pnenmonia, PDA, congenital heart disease, pulmonary hypertension, meconium aspiration, and pulmonary hypoplasia. - Whether retreatment of RDS with surfactant after resolution of these factors is nsefnl is currently unknown. 

Lonnqvist, P.-A., Winberg, P., Lundell, B., Sellden, H., and Olsson, G. L. (1994). Inhaled nitric oxide in neonates and children with pulmonary hypertension. Acta Paediatr. Scand. 83, 1132-1136. 

Inhaled Nitric Oxide Therapy of Pulmonary Hypertension and Respiratory Failure in Premature and Term Neonates... 

The purpose of this chapter is to briefly review selected aspects of the experimental basis for NO therapy of pulmonary hypertension and respiratory failure in PPHN and its potential role in treating severe RDS associated with prematurity. We further summarize current clinical data regarding the efficacy and safety of this treatment in term and preterm human neonates. 

Potential mechanisms associated with poor NO responses in PPHN may include (1) its use in hypoxemic neonates without pulmonary hypertension,... 

Some premature neonates with severe RDS have evidence of high PVR, which can exacerbate hypoxemia due to right-to-left shunting across the ductus arteriosus or the foramen ovale (66). Pulmonary hypertension may... 

Walther, F. J., Benders, M. J., and Leighton, J. O. (1992). Persistent pulmonary hypertension in premature neonates with severe respiratory distress syndrome. Pediatrics 90, 899-904. 

While prolonged therapy with nitric oxide may prove to be useful in the management of the postoperative neonate, care must be exercised whenever nitric oxide use is discontinued. Abrupt withdrawal of therapy, prior to resolution of the underlying disease, may precipitate a pulmonary hypertensive crisis, as occurred in one of our patients. This was promptly and effectively treated with the reintroduction of a low dose of nitric oxide (Fig. 8). Cautious weaning of the dose is advisable. 

Vosatka, R., Kashyap, S., and Trifiletti, R. (1994). Arginine deficiency accompanies persistent pulmonary hypertension of the newborn. Biol. Neonate 66, 65-70. 

In contrast, drugs that release endogenous nitric oxide and donors of the molecule were in use long before nitric oxide was discovered and continue to be very important in clinical medicine. The cardiovascular applications of nitroprusside (Chapter 11) and the nitrates and nitrites (Chapter 12) have been discussed. The treatments of preeclampsia and of pulmonary hypertension and acute respiratory distress syndrome are currently under clinical investigation. Early results from the pulmonary disease studies appear promising, and one preparation of nitric oxide gas (INOmax) has been approved for use in neonates with hypoxic respiratory failure. 

Simple 2-benzylimidazoIines (30-33) were prepared by condensation of the appropriate phenylacetonitrile (29) with ethylenediamine either at elevated temperatures or in the presence of catalytic amounts of carbon disulphide Scheme 5.9.). Tolazoline was also prepared in high yield by Neefs method [24]. Tolazoline (30) [25, 26] is a vasodilator but, domazoline (31) [27], xylometazoline (32) [28] and oxymetazoline (33) [29] are all vasoconstrictors. Oxymetazoline was shown to be an agonist for both pre- and post-synaptic a2-adrenergic receptors [30], Tolazoline can be used in animals to give rapid arousal from anaesthesia, for example it is reported to reverse the effect of xylazine with ketamide in wolves [31], white tailed deer [32] and elephants [33], in each case it was fully effective and caused no distress to the animals. It is useful in neonates such as lambs and calves to treat persistent foetal circulation syndrome (persistant pulmonary hypertension) [34] and is recommended for the same condition in human newborns [35, 36]. Oxymetazoline found use in dentistry as a gingival retraction agent [38]. 

A1 M, Barbin C, Martinez H, Aly A, Fonseca R. Maternal use of cyclobenzaprine (Hexeril) may induce ductal closure and persistent pulmonary hypertension in neonates. J Matern Fetal Neonatal Med 2014 27(ll) 1177-9. 

O Rourke, RR, et al. 1989. Extracorporeal membrane oxygenation and conventional medical therapy in neonates with persistent pulmonary hypertension of the newborn A prospective randomized study. Pediatrics 84(6) 957-63. 

---