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Pulmonary hypertension of the Newborn

Kirsten Rowcliff, Koert de Waal, Abdel-Latif Mohamed, Tejasvi Chaudhari
: Noradrenaline (NA) is beneficial in the treatment of term newborns with cardiovascular compromise due to sepsis or pulmonary hypertension, but experiences with NA in preterm infants are limited. The aim of this study is to describe the efficacy and safety of NA in preterm infants. Patient records of preterm infants ≤32 weeks' gestation admitted to two hospitals between 2004 and 2015 and who received NA were reviewed for perinatal morbidities and mortality. Clinical details were collected at the time of NA use, and response on blood pressure, perfusion and oxygenation was documented as well as possible side effects...
October 15, 2016: European Journal of Pediatrics
Luke R Putnam, Kuojen Tsao, Francesco Morini, Pamela A Lally, Charles C Miller, Kevin P Lally, Matthew T Harting
Importance: Inhaled nitric oxide (iNO) is an expensive, commonly used therapy among patients with congenital diaphragmatic hernia (CDH); however, data to support its ongoing use in this patient population are lacking. Objective: To describe the spectrum of iNO use among patients with CDH and its association with pulmonary hypertension (pHTN) and mortality. Design, Setting, and Participants: A review was conducted of prospectively collected patient data in the Congenital Diaphragmatic Hernia Study Group registry between January 1, 2007, and December 31, 2014, from 70 participating centers in 13 countries...
October 10, 2016: JAMA Pediatrics
Ibrahim Sammour, Santhosh Somashekar, Jian Huang, Sunil Batlahally, Matthew Breton, Krystalenia Valasaki, Aisha Khan, Shu Wu, Karen C Young
BACKGROUND: Mesenchymal stem cells (MSC) improve alveolar and vascular structures in experimental models of bronchopulmonary dysplasia (BPD). Female MSC secrete more anti-inflammatory and pro-angiogenic factors as compared to male MSC. Whether the therapeutic efficacy of MSC in attenuating lung injury in an experimental model of BPD is influenced by the sex of the donor MSC or recipient is unknown. Here we tested the hypothesis that female MSC would have greater lung regenerative properties than male MSC in experimental BPD and this benefit would be more evident in males...
2016: PloS One
R Sahni, X Ameer, K Ohira-Kist, J-T Wung
OBJECTIVES: Inhaled nitric oxide (iNO) is effective in conjunction with tracheal intubation (TI) and mechanical ventilation (MV) for treating arterial pulmonary hypertension and hypoxemic respiratory failure (HRF) in near-term and term newborns. Non-invasive respiratory support with nasal continuous positive airway pressure (CPAP) is increasingly used to avoid morbidity associated with TI and MV, yet the effectiveness of iNO delivery via nasal CPAP remains unknown. To evaluate the effectiveness of iNO delivered via the bubble nasal CPAP system in term and preterm newborns with HRF...
October 6, 2016: Journal of Perinatology: Official Journal of the California Perinatal Association
Eiji Hirakawa, Satoshi Ibara, Takuya Tokuhisa, Yoshinobu Maede, Takako Kuwahara, Chie Ishihara, Hiroyuki Noguchi, Yoshiki Naitou, Masakatsu Yamamoto, Masaya Kibe, Tsuyoshi Yamamoto, Tomonori Kurimoto, Masato Kamitomo, Kazutoshi Cho, Hisanori Minakami
BACKGROUND: There have been few reports regarding outcomes after extracorporeal membrane oxygenation (ECMO) in newborn Japanese infants. METHODS: A review of 61 neonates with ECMO through January 1995 at a single center was performed. ECMO was used in neonates with oxygenation index > 20 after conventional treatments. Background factors, such as etiology, vascular access mode (veno-venous [VV] or veno-arterial [VA]), number of days with ECMO, and early ECMO (within 24 hours after birth), were analyzed in relation to outcome with respect to survival to hospital discharge (SHD)...
October 3, 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
Mathew J Wong, Crystal Kantores, Julijana Ivanovska, Amish Jain, Robert P Jankov
Chronic neonatal pulmonary hypertension (PHT) frequently results in early death. Systemically administered Rho-kinase (ROCK) inhibitors prevent and reverse chronic PHT in neonatal rats, but at the cost of severe adverse effects, including systemic hypotension and growth restriction. Simvastatin has pleiotropic inhibitory effects on isoprenoid intermediates that may limit activity of RhoA, which signals upstream of ROCK. We therefore hypothesized that statin treatment would safely limit pulmonary vascular RhoA activity and prevent and reverse experimental chronic neonatal PHT via downstream inhibitory effects on pathological ROCK activity...
September 30, 2016: American Journal of Physiology. Lung Cellular and Molecular Physiology
Kathryn Browning Carmo, Tracey Lutz, Andrew Berry, Martin Kluckow, Nick Evans
AIM: To determine the role of clinician performed ultrasound (CPU) during the retrieval and transport of critically ill term and near term newborns. METHODS: A neonatologist with portable ultrasound accompanied a sample of newborn retrievals to perform cardiac and cerebral ultrasound before and after transportation. RESULTS: A total of fifty-five babies were studied. Median birthweight: 3350 g (2220-5030 g). CPU led to a change in the planned receiving hospital in ten babies...
September 15, 2016: Acta Paediatrica
Meryem Kurek Eken, Abdülhamit Tüten, Enis Özkaya, Güner Karatekin, Ateş Karateke
OBJECTIVE: To assess the predictors of outcome in terms of length of stay in the neonatal intensive care unit (NICU) and survival of neonates from women with preterm premature rupture of membranes (PPROM). METHODS: A population-based retrospective study including three hundred thirty-one singleton pregnant women with PPROM at 24-34 gestational weeks between January 2013 and December 2015 was conducted. Gestational age at delivery, birth weight, route of delivery, newborn gender, maternal age,oligohydramnios, premature retinopathy (ROP), necrotising enterocolitis (NEC), sepsis, fetal growth retardation (FGR), intracranial hemorrhagia (ICH), bronchopulmonary dysplasia (BPD), respiratory distress syndrome (RDS), primary pulmonary hypertension (PPH), congenital cardiac disease (CCD), patent ductus arteriosus (PDA), use of cortisol (betamethasone) and maternal complications including gestational diabetes, preeclampsia, and chorioamnionitis were used to predict neonatal outcomes in terms of length of stay in the NICU and survival...
September 14, 2016: Journal of Maternal-fetal & Neonatal Medicine
Andrew K Ewer
The detection of newborn babies with potentially life-threatening, critical congenital heart defects (CCHDs) before they collapse or expire remains an important clinical challenge. The absence of physical signs and the difficulty assessing mild cyanosis means that the newborn baby check misses up to a third of babies. Fetal anomaly ultrasound scanning identifies an increasing proportion, but this screen is operator-dependent and therefore highly variable; although some units report very high detection rates, overall most babies with CCHD are still missed...
September 2016: American Journal of Perinatology
N Nakwan, P Chaiwiriyawong
OBJECTIVE: To assess the current practice preferences in diagnosis and management of persistent hypertension of the newborn (PPHN) of neonatologists or pediatricians with expertise in neonatal care. STUDY DESIGN: Investigators identified potential participants worldwide through a literature search. They were emailed the URL of an online 25-item questionnaire through the web survey site SurveyMonkey®. Additional respondents were also acquired through a professional online discussion group...
September 16, 2016: Journal of Neonatal-perinatal Medicine
S Al Omar, H Salama, M Al Hail, H Al Rifai, M Bunahia, W El Kasem, F J Siddiqui, M Dilawar, H Yassin, F Masud, A Mohamed, A Mansour
INTRODUCTION: Inhaled nitric oxide (iNO) is the standard therapy for infants with persistent pulmonary hypertension of the newborn (PPHN). Recently, sildenafil has been evaluated as an alternative or adjunctive pulmonary vasodilator. OBJECTIVE: To assess the effectiveness of adding sildenafil as an early adjunctive therapy together with iNO when treating newborns with PPHN and/or hypoxemic respiratory failure. METHODS: This is a randomized placebo trial on newborns with gestational age > 34 weeks, postnatal age < 48 hours, and diagnosed with PPHN (oxygen index (OI) ≥ 20)...
September 16, 2016: Journal of Neonatal-perinatal Medicine
Khairul Zainun, Kirsten Hope, Andrew G Nicholson, Marta Cecilia Cohen
Abnormal muscularization of intra acinar pulmonary arteries is a histological hallmark of persistent pulmonary hypertension of newborn (PPHN), an uncommon disease with high morbidity and mortality. PPHN presents with signs of respiratory distress immediately following birth. The disease is multi-factorial in origin and can be idiopathic as well associated with a variety of conditions such as congenital heart disease and both congenital and acquired lung diseases. We report two cases presenting as sudden unexpected death in late neonatal period (SUDI) showing abnormal muscularization of acinar pulmonary arteries reminiscent of PPHN...
August 30, 2016: Pediatric and Developmental Pathology
Nem-Yun Boo, Irene Guat-Sim Cheah
INTRODUCTION: This study aimed to determine the incidence of hypoxic-ischaemic encephalopathy (HIE) and predictors of HIE mortality in Malaysian neonatal intensive care units (NICUs). METHODS: This was a retrospective study of data from 37 NICUs in the Malaysian National Neonatal Registry in 2012. All newborns with gestational age ≥ 36 weeks, without major congenital malformations and fulfilling the criteria of HIE were included. RESULTS: There were 285,454 live births in these hospitals...
August 2016: Singapore Medical Journal
Anna Dikalova, Judy L Aschner, Mark R Kaplowitz, Marshall Summar, Candice D Fike
We previously showed that newborn piglets who develop pulmonary hypertension during exposure to chronic hypoxia have diminished pulmonary vascular nitric oxide (NO) production and evidence of endothelial NO synthase (eNOS) uncoupling (Fike CD, Dikalova A, Kaplowitz MR, Cunningham G, Summar M, Aschner JL. Am J Respir Cell Mol Biol 53: 255-264, 2015). Tetrahydrobiopterin (BH4) is a cofactor that promotes eNOS coupling. Current clinical strategies typically invoke initiating treatment after the diagnosis of pulmonary hypertension, rather than prophylactically...
October 1, 2016: American Journal of Physiology. Lung Cellular and Molecular Physiology
Sebastián Castillo-Galán, Sebastián Quezada, Fernando A Moraga, Germán Ebensperger, Emilio A Herrera, Felipe Beñaldo, Ismael Hernandez, Renato Ebensperger, Santiago Ramirez, Anibal J Llanos, Roberto V Reyes
Calcium signaling through store operated channels (SOC) is involved in hypoxic pulmonary hypertension. We determined whether a treatment with 2-aminoethyldiphenylborinate (2-APB), a compound with SOC blocker activity, reduces pulmonary hypertension and vascular remodeling. Twelve newborn lambs exposed to perinatal chronic hypoxia were studied, 6 of them received a 2-APB treatment and the other 6 received vehicle treatment, for 10 days in both cases. Throughout this period, we recorded cardiopulmonary variables and on day 11 we evaluated the response to an acute hypoxic challenge...
August 19, 2016: American Journal of Physiology. Lung Cellular and Molecular Physiology
Kiran More, Gayatri K Athalye-Jape, Shripada C Rao, Sanjay K Patole
BACKGROUND: Endothelin, a powerful vasoconstrictor, is one of the mediators in the causation of persistent pulmonary hypertension of the newborn (PPHN). Theoretically, endothelin receptor antagonists (ETRA) have the potential to improve the outcomes of infants with PPHN. OBJECTIVES: To assess the efficacy and safety of ETRA in the treatment of PPHN in full-term, post-term and late preterm infants.To assess the efficacy and safety of selective ETRAs (which block only the ETA receptors) and non-selective ETRAs (which block both ETA and ETB receptors) separately...
2016: Cochrane Database of Systematic Reviews
Michelle L Baack, Benjamin J Forred, Tricia D Larsen, Danielle N Jensen, Angela L Wachal, Muhammad Ali Khan, Peter F Vitiello
RATIONALE: Infants born to diabetic or obese mothers are at risk of respiratory distress and persistent pulmonary hypertension of the newborn (PPHN), conceivably through fuel-mediated pathogenic mechanisms. Prior research and preventative measures focus on controlling maternal hyperglycemia, but growing evidence suggests a role for additional circulating fuels including lipids. Little is known about the individual or additive effects of a maternal high-fat diet on fetal lung development...
2016: PloS One
Merja Kallio, Ulla Koskela, Outi Peltoniemi, Tero Kontiokari, Tytti Pokka, Maria Suo-Palosaari, Timo Saarela
UNLABELLED: Neurally adjusted ventilatory assist (NAVA) improves patient-ventilator synchrony during invasive ventilation and leads to lower peak inspiratory pressures (PIP) and oxygen requirements. The aim of this trial was to compare NAVA with current standard ventilation in preterm infants in terms of the duration of invasive ventilation. Sixty infants born between 28 + 0 and 36 + 6 weeks of gestation and requiring invasive ventilation due to neonatal respiratory distress syndrome (RDS) were randomized to conventional ventilation or NAVA...
September 2016: European Journal of Pediatrics
Robin H Steinhorn, Jeffrey Fineman, Andjela Kusic-Pajic, Peter Cornelisse, Martine Gehin, Pegah Nowbakht, Christine M Pierce, Maurice Beghetti
OBJECTIVE: To evaluate the efficacy, safety, and pharmacokinetics of the endothelin receptor antagonist bosentan as adjunctive therapy for neonates with persistent pulmonary hypertension of the newborn (PPHN). STUDY DESIGN: This was a phase 3, multicenter, randomized, placebo-controlled exploratory trial (FUTURE-4). Eligible patients were >34 weeks gestation, <7 days old, receiving inhaled nitric oxide (iNO) treatment (≥4 hours), and had persistent respiratory failure (oxygenation index [OI] ≥12)...
October 2016: Journal of Pediatrics
Margrete Larsen Burns, Hans Jørgen Stensvold, Kari Risnes, Hans Jørgen Guthe, Henriette Astrup, S Marianne Nordhov, Terje Reidar Selberg, Arild Rønnestad, Astri Maria Lang
OBJECTIVE: To describe the use of inotropic drugs and the characteristics of neonates receiving such treatment in a national cohort of patients admitted to neonatal ICUs in Norway. DESIGN: A national registry study of patients included in the Norwegian Neonatal Network database 2009-2014. Demographic and treatment data, including the use of inotropic drugs (dopamine, dobutamine, epinephrine, norepinephrine, milrinone, and levosimendan) and outcomes, were retrieved and analyzed...
October 2016: Pediatric Critical Care Medicine
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