Inhaled Epoprostenol for Pulmonary Hypertension Treatment in Neonates: A 12-Year Experience.

Background: Persistent pulmonary hypertension of the newborn (PPHN) occurs in 10% of neonatal respiratory insufficiency. To selectively reduce pulmonary vascular resistance, several treatments have been tried. Inhaled epoprostenol (iPGI ₂ ) has been used for 12 years in our institution for the management of refractory PPHN despite the gaps in the literature to support this use.
Objectives: The primary objective was to evaluate the efficacy of iPGI ₂ for PPHN. The secondary objectives were to describe its use in neonates and assess side effects.
Study Design: This retrospective cohort study included infants < 28 days with PPHN treated with iPGI ₂ in the neonatal or pediatric intensive care units of our institution between 2004 and 2016.
Results: We reviewed 43 patient' care episodes (mean gestational age of 36 weeks). This was an extremely ill population with 54% mortality rate. Oxygenation index improved significantly after 12-hour treatment ( p  = 0.047), with a rebound effect when discontinuing nebulization. By the end of the therapy, the fraction of inspired oxygen had significantly dropped ( p  = 0.0018). Echocardiographic markers tended to normalize during treatment. No potential side effects were reported.
Conclusion: In these sick newborns, we observed an improvement in PPHN under iPGI ₂ without significant adverse effects. To our knowledge, this is the largest neonatal cohort reported to have received iPGI ₂ for PPHN.
Competing Interests: None declared.
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