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selvanr4

99nicu Poll: What is your pharmaceutical management option for PPHN of a term newborn in your institution?

What is your pharmaceutical management for PPHN in a term newborn? (several options allowed)  

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It is very tricky to treat and stabilize resistant cases with PPHN .

Now as mentioned earlier; our targets are : a) Maintain OXYGENATION (we aim to maintain above 95%) B) to maintain systemic pressure (we aim to maintain above 55-60 of mean).

Now again as requested we are talking about term babies.

It is a big challenge; so bypassing the high pressure (which can frequentely cause air leak) and high FiO2 on conventional ventilation. Nitric is really of great help. We usually start at 20 PPM. We do not use Sildenafil that frequent.

Higher maps in HFOV can help but again with caution.

When we come to the point where Oxygenation index exceeding 45 to 50; we start to think about ECMO.

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Hi all

We use sildenafil (per Os), hyperventilation, hyperoxygenation, dopamine, dobutamine. But unfortunally we still have no NO in our nicu

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Well as a basic principle we try to maintain oyxgenation above SpO2 95%, avoid any acidosis (use hydrogencarbonate if necessary), ascertain normothermia, and try to keep systemic blood pressure slightly above normal.

Achieving these goals may include the use of HFOV and the use of different inotropes like dobutamine, low-dose adrenaline (0.05µg/kg/min), noradrenaline or milrinone followed by hydrocortisone. We also include iNO (starting 20 ppm) if inotropes are ineffective. We rarely use sildenafil primarily.

 

I would be interested to know how you combine inotropes? Start dobutamine first? Then add noradrenaline (to what max. dosage)?

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our main aim is to optimize oxygenation,prevent acidosis and agitation and sidenafil.we use surfactant case to case basis.NO is used only when infant does not respond to above measures as well as to dopa and milrinone.

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In response to one of the above comments, we have tried IV Pulmosil in our unit a couple of times, with good results and no immediate problems. Too early to say how it compares with oral sildenafil, though, which is tried and tested, and most important, cheap!

 

IV sildenafil dosage that we used was 0.4 mg/kg over 3 hours, followed by 1.6 mg/kg/day.

 

Word of caution about concomitant use with iNO. A study by Shekerdemian et al on piglets with meconium aspiration said that combined use resulted in worsening oxygenation and hypotension. (However, a more recent, multicenter study by Steinhorn et al (2003-05) says it did not!)

 

It was a moot point for us, though, as our unit has no iNO...

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sadly we dont have NO in our unit .

we do use mgsulphate with dop/doput, to maintain syst.circuation.

about sildenafil .. we get used not to use it ,

really iam impressed with your success rate with this drug ,

any study to support its use???

thanks

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