Refractory Persistent Pulmonary Hypertension of the Newborn Responsive Only to Neuromuscular Blockade

We discuss the case of a premature newborn boy presenting with severe persistent pulmonary hypertension (PPHN) at 48 hours of life in the context of Staphylococcus aureus sepsis. PPHN was refractory to classical treatment (oxygen, control of acid basic balance, sedation, high frequency oscillation ventilation, inhaled nitric oxide and antibiotics). We observed an improvement only after administration of a curare. Despite much progress in the management of this entity, a clear and well defined therapy is still missing and especially when PPHN is refractory to classical treatment . The use of neuromuscular blockers in the treatment of this kind of PPHN has been described and some physiological explanations are likely. N euromuscular blocking agents are rarely useful to treat PPHN since the introduction of iNO, nevertheless, it might still be a useful rescue therapy in some selected newborns with PPHN refractory to classical treatments. doi: http://dx.doi.org/10.4021/jmc1114w

[1]  P. McNamara,et al.  Variation in the Management of Persistent Pulmonary Hypertension of the Newborn: A Survey of Physicians in Canada, Australia, and New Zealand , 2012, American Journal of Perinatology.

[2]  R. Steinhorn,et al.  Pulmonary vasodilator therapy in the NICU: inhaled nitric oxide, sildenafil, and other pulmonary vasodilating agents. , 2012, Clinics in perinatology.

[3]  J. Fineman,et al.  Advances in the Management of Pediatric Pulmonary Hypertension , 2011, Respiratory Care.

[4]  P. Fiorini,et al.  Persistent pulmonary hypertension of the newborn refractory to inhaled nitric oxide and prostacyclin, responsive to neuromuscular blockade. , 2011, Minerva pediatrica.

[5]  Y. Kwan,et al.  An in vitro study of histamine on the pulmonary artery of the Wistar-Kyoto and spontaneously hypertensive rats. , 2003, European journal of pharmacology.

[6]  J. Tyson,et al.  Persistent Pulmonary Hypertension of the Newborn in the Era Before Nitric Oxide: Practice Variation and Outcomes , 2000, Pediatrics.

[7]  V. Yu,et al.  Curare in the treatment of pulmonary hypertension as it occurs in the idiopathic respiratory distress syndrome , 1980, Australian paediatric journal.

[8]  R. Schreiner,et al.  Respiratory paralysis to improve oxygenation and mortality in large newborn infants with respiratory distress. , 1979, Journal of pediatric surgery.

[9]  M. Heymann,et al.  Persistent pulmonary hypertension of the newborn infant. , 1976, The Journal of pediatrics.

[10]  E. K. Weir,et al.  Histamine H1- and H2-receptors in pulmonary and systemic vasculature of the dog. , 1975, The American journal of physiology.