Jump to content

JOIN THE DISCUSSION!

Want to join the discussions?

Sign up for a free membership! 

If you are a member already, log in!

(lost your password? reset it here)

99nicu.org 99nicu.org

PPHN and surfactant


PRAKASH KABBUR

Recommended Posts

I would like to know what the forum members feel regarding these two scenario: 

1. Term infant with signs of PPHN, CXR: dark lung fields ( idiopathic/primary PPHN), well expanded, on HFOV, ECHO: PPHN. Preductal sats in the 70s-80s. Do you give surfactant or go straight to iNO? There is expert opinion that giving surfactant in these situations worsen the clinical situation. Please share your experience/available literature. 

2. Term infant with GBS positive mother. She was started on GBS prophylaxis as per ACOG guidelines when she was in labor and she gets one dose and miss subsequent two doses, prolonged labor. Last dose of antibiotic was given 8-12h ago. Baby is well on exam, no chorioamnionitis diagnosis by OB. Mother request early discharge at 24h. Do yo consider this as adequate IAP and discharge baby or watch baby for 48h as per AAP guidelines? Also, another case of mother receiving AIP 3h prior to delivery and she request discharge at 24h. Please share your practice. Thank you

Link to comment
Share on other sites

2# if mother received B. Penicillin or Ampicillin or cefazolin more than 4 hes before delivery is considered adequate prophylaxis. 
observation can be enough for 24 hrs if parents are well educated regarding warning signs and have immediate access to clinical services.

1# first of all is ensure adequate recruitment with adequate ventilation then consider surfactant if fio2 requirements still high.

2# to check how much is pulmonary pressure and cardiac function before starting iNO.

if adequate myocardial function, can start iNo. If not don’t give.

start inotropes to increase your Systemic pressure above pulmonary pressure.

adequate sedation and pain management and minimal handling 

 

Link to comment
Share on other sites

I will just go for number one.  

NO surfactant.  You do not have a CXR indicative of RDS.  You have an infant with existing pulmonary hypertension, and clogging the airway with unneeded surfactant will only worsen the disease process.  

Just as you would not bolus a child with saline to treat hypoglycemia, do not give the wrong drug to treat PPHN.

Link to comment
Share on other sites

9 hours ago, Alaa said:

2# if mother received B. Penicillin or Ampicillin or cefazolin more than 4 hes before delivery is considered adequate prophylaxis. 
observation can be enough for 24 hrs if parents are well educated regarding warning signs and have immediate access to clinical services.

1# first of all is ensure adequate recruitment with adequate ventilation then consider surfactant if fio2 requirements still high.

2# to check how much is pulmonary pressure and cardiac function before starting iNO.

if adequate myocardial function, can start iNo. If not don’t give.

start inotropes to increase your Systemic pressure above pulmonary pressure.

adequate sedation and pain management and minimal handling 

 

Thank you

  • Like 1
Link to comment
Share on other sites

1) Surfactant in a PPHN situation will give a transient endogen NO-release in the lungs improving SpO2 in the short term. For the long term it is better to start iNO.

1) Surfactant might be indicated in a situation of meconium aspiration syndrome driven PPHN.

1) Regardless, if oxygen index is above 20 (30) = start iNO.

  • Like 1
Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
×
×
  • Create New...