Adenosine infusion for the management of persistent pulmonary hypertension of the newborn.

Abstract

OBJECTIVE:

To determine the effect of adenosine for the management of persistent pulmonary hypertension of the newborn.

DESIGN:

Prospective, observational case series report.

SETTING:

A single, tertiary referral neonatal intensive care unit.

PATIENTS:

Nine neonates with persistent pulmonary hypertension of the newborn requiring mechanical ventilation and inhaled nitric oxide at 20 parts per million.

INTERVENTIONS:

A continuous intravenous infusion of adenosine at 50 microg/kg/min.

MEASUREMENTS AND MAIN RESULTS:

Peripheral arterial oxygen saturation, arterial oxygen tension, invasive systemic arterial blood pressure, and pulmonary arterial pressure, estimated using echocardiography, were recorded. There was a significant improvement in arterial oxygenation tension in six of nine neonates who responded to adenosine: PaO2 increased from 66.8 (range, 47-70.5) torr (8.8 kPa) to 73.5 (range, 58.5-94.2) (p=.02) and pulmonary arterial pressure decreased significantly from 63 (range, 42.5-64.0) to 43.5 (range, 32.75-49) mm Hg (p=.002). The pulmonary to systemic mean artery pressure ratio fell from 1.27 (range, 0.88-1.5) to 0.81 (range, 0.64-0.84) (p=.002). Three neonates did not respond to adenosine infusion.

CONCLUSIONS:

The use of adenosine infusion in combination with inhaled nitric oxide may be a potentially valuable therapeutic option for the treatment of pulmonary hypertension of the newborn. Neonates with irreversible lung pathology may not respond to adenosine infusion.

• Authors: Cho Ng, Orla Franklin, Mamta Vaidya, Christine Pierce, Andy Petros
• Journal: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (Pediatr Crit Care Med) Vol. 5 Issue 1 Pg. 10-3 (Jan 2004) ISSN: 1529-7535 [Print] United States
• PMID: 14697102 (Publication Type: Clinical Trial, Journal Article)

Chemical References

• Vasodilator Agents
• Nitric Oxide
• Adenosine

Topics

• Adenosine (therapeutic use)
• Administration, Inhalation
• Drug Therapy, Combination
• Humans
• Infant, Newborn
• Infusions, Intravenous
• Nitric Oxide (therapeutic use)
• Persistent Fetal Circulation Syndrome (drug therapy)
• Prospective Studies
• Vasodilator Agents (therapeutic use)