magnesium sulfate for PPHN

[ismailelhawary]

hello everyone,i would like to know if magnesium sulfate can be used routinely in the treatment of PPHN ,and if so what is the recommended dose??? we have no inhaled nitric oxide and we tried oral sildenafil with unsatisfactory results.thanks:)

[JACK]

Magnesium Sulphate is used for treatment of PPHN when you dont have inhaled nitric oxide available. It is effective but has serious side effects.

These links should be helpful in answering your questions:

- CLICK LINK 1

Please note the units for Serum Magnesium monitoring in the link above. Depending on your lab you may need to convert them to mg/dL .

- CLICK LINK 2

- CLICK LINK 3

I hope that helps. We have also used Magnesium SUlphate in dire circumstances with good results for PPHN.

Though I strongly recommend you to convince your management in trying to procure one inhaled nitric oxide apparatus.

[Guest Dr. Petrov]

Hello. We have a similar situation with absense of NO. So, we start with initial dose MgSO2 25% 200 mg/kg/hour with strong control of systemic blood pressure. After that we continue constant infusion 50 mg/kg/h. Criterias of effectiveness are improvement of oxigenation and datas from EchoCG (deminishing of pulmonary pressure and tricuspidal insufficiensy). Main possible problems are deminishing of systemic blood pressure due to vasodilatation (usually we correct it with bolus of normal saline 10 ml/kg/h) and sedation (but often such child is on ventilation so may be it is not so bad). We use oral sildenafil only for chronic PPHN, for example due to BPD.

[ctestolin]

I would suggest some articles:

1) New approaches for persistent pulmonary hypertension of newborn G. Ganesh Konduri, MD Clin Perinatol 31 (2004) 591–611

2) PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN Rational Therapy Based on Pathophysiology Michele C. Walsh, MD, MS, and Eileen K. Stork, MD CLINICS IN PERINATOLOGY VOLUME 28 * NUMBER 3 * SEPTEMBER 2001 pag 609-627

3) Incidence of alveolar capillary dysplasia in severe idiopathic persistent pulmonary hypertension of the newborn J TIBBALLS and CW CHOW J. Paediatr. Child Health

(2002) 38, 397–400

4) Alveolar capillary dysplasia: a logical approach to a fatal disease Journal of Pediatric Surgery (2005) 40, 1100– 1105

In my NICU we use iNO with wonderful results. We had a case of iNO-not responder term baby but the final (and fatal) diagnosis was Alveolar Capillary Dysplasia

[ismailelhawary]

thank you jack,dr petrov and ctestolin for your replies,they were more than helpful,

[selvanr4]

Please do a search for MAS & PPHN in 99nicu web page. A real case was discussed 18 months back and it;s worth going through again.

[drakjaleel]

Dear dr selvan we also tried Mgso4 for MAS/PPHN but many times it is not encouraging outcomes.As of now we have HFO with oral Sildnafil with reasonable intact survival.To Prof Jack- would like to know how one should suspect Pulmonary Alveolar Dysplasia.Thanks.