Stefan Johansson Posted March 9, 2015 Share Posted March 9, 2015 Just wanted to share a recent and good experience with inhalation of epoprostenol in PPHN. I currently work in a large level2-unit (≈8000 inborn/y) with no access to NO-inhalation. Infants born in our delivery ward with PPHN and needing level-3-care (i.e. NO/mechanical ventilation) needs to be transferred. We recently had a baby with echo-verified PPHN, on CPAP and with saturations around 88-90% on 100% oxygen. While preparing for premed/relaxation and intubation we connected our CPAP inhalation device and inhaled epoprostenol with surprisingly good response! We avoided intubation and transfer. We gave two inhalations about 30 min apart initially, and shortly our saturations were >95% and could start to decrease FiO2. Doses were repeated every 2nd hour until we reached FiO2 <0.5, in total the baby recieved five inhalations. Before/during and after - the baby was cardiovascular stable (stable normal BP and pulse) and the 2nd echo at about 4h of age showed balanced shunt over the open duct (as opposed to right-left shunting at 1.5h after birth). We used the dose suggested in this article: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342750/ Link to comment Share on other sites More sharing options...
peesay Posted March 11, 2015 Share Posted March 11, 2015 Sounds interesting. Did the parents give permission to this experimental drug? The pH of the inhaled epiprostenol PGI2 is 10 and so what are side effects? Link to comment Share on other sites More sharing options...
Stefan Johansson Posted March 11, 2015 Author Share Posted March 11, 2015 Parents were informed of course. We also considered we could use epoprostenol off-label (like how we use most other drugs in the NICU) as others had used and reported about doses and responses in publications available on Pubmed. In addition to case reports in this review from 2014 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3942674/), there are several case-reports and -series in the literature: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342750/ http://pediatrics.aappublications.org/content/130/2/e442.long http://www.ncbi.nlm.nih.gov/pubmed/12461501 While doing some research on this option last year I also found this news story from a hospital in California, not a peer-reviewed paper but adds a perspective also. http://www.childrenscentralcal.org/PressRoom/IncredibleCare/Pages/ReducingCosts.aspx Link to comment Share on other sites More sharing options...
tarek Posted March 12, 2015 Share Posted March 12, 2015 May i ask how much is the cost of this medication ? Is it same like ponsenten orally Link to comment Share on other sites More sharing options...
Stefan Johansson Posted March 13, 2015 Author Share Posted March 13, 2015 May i ask how much is the cost of this medication ? Is it same like ponsenten orally I don't know the cost. But we have the drug "in stock" as we sometimes (rarely) use it iv (http://www.ncbi.nlm.nih.gov/pubmed/8960484). However, as our experience with iv-use is not good we have tried inhalation in a few cases using the prepared iv-solution (1000 nanogram/ml). As the inhaled dose (suggested in article above) is 50 ng/kg, we have added with NaCl up to a volume of 2 ml. Link to comment Share on other sites More sharing options...
wackdi Posted March 17, 2015 Share Posted March 17, 2015 Very interesting! In the past I had good experience by using Sildenafil enterally (by gastic tube). As I am now working in a Level III NICU i recently found an article about using Vasopressin a adjuvant treatment: http://www.ncbi.nlm.nih.gov/pubmed/24141655 Does anyone have any experience with this drug? Greetings from Sweden Dirk Link to comment Share on other sites More sharing options...
drakjaleel Posted March 20, 2015 Share Posted March 20, 2015 Good information great work please update further about the drug Link to comment Share on other sites More sharing options...
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