COMPARISON BETWEEN EFFECTIVENESS OF MAGNESIUM SULPHATE VERSUS MILRINONE IN NEONATAL PULMONARY HYPERTE
Ahmed Maher Soliman Ghaly;
Abstract
P
ersistent pulmonary hypertension of the newborn PPHN is a cardiopulmonary disorder characterized by systemic arterial hypoxemia secondary to elevated pulmonary vascular resistance with resultant shunting of pulmonary blood flow to the systemic circulation.
Diagnosis of PPHN is made by characteristic liability in oxygenation of the baby, echocardiographic evidence of increased pulmonary pressure, with demonstrable shunt across the ductus arteriosus or foramen ovale, and the absence of cyanotic heart disease lesions.
Management of the disease includes treatment of underlying causes sedation and analgesia, maintenance of adequate systemic blood pressure, and ventilator and pharmacologic measures to increase pulmonary vasodilatation, decrease PVR, increase blood and tissue oxygenation and normalize blood PH. If all other treatments fail, ECMO can be used. Currently the therapeutic mainstay for PPHN is optimal lung inflation and selective vasodilatation with (iNO). However iNO is'nt available and not all infants will respond to it. Milrinone is a phosphodiesteras III inhibitor which induces pulmonary vasodilatation by its action through a CAMP mediated signaling pathway.
Magnesium sulfate (MgSO4) is a natural Ca channel blocker that antagonizes Ca ion entry into smooth muscle cell thus promoting vasodilatation. MgSO4 is a safe and cheaper alternative for first line treatment in moderate PPHN and was chosen to be an alternative therapy for PPHN when other conventional treatments fail, are contraindicated or are not available.
During the study, 40 neonates were included and they were divided into two groups: the first group (group I) represented 20 neonates were treated by Milrinone. Whereas the second group (groupII) represented 20 neonates treated by MgSo4.
Our study revealed that good improvement in PAP with two groups with more side effects inMgSo4 group as hypotension.
We noticed that group I treated by Milrinone was elevated PPHN than group II.
In our study the use of milrinone as an adjuvant to conventional therapy was effective when used in neonate with moderate to severe PPHN. Its use was associated with significant improvement of oxygen saturation, ABGs and systolic pulmonary artery pressure. There was no effect on systemic blood pressure and neonates who received milrinone did not become hypotensive. On the other hand, there was a significant drop in heart rate after 8-24 hours.
ersistent pulmonary hypertension of the newborn PPHN is a cardiopulmonary disorder characterized by systemic arterial hypoxemia secondary to elevated pulmonary vascular resistance with resultant shunting of pulmonary blood flow to the systemic circulation.
Diagnosis of PPHN is made by characteristic liability in oxygenation of the baby, echocardiographic evidence of increased pulmonary pressure, with demonstrable shunt across the ductus arteriosus or foramen ovale, and the absence of cyanotic heart disease lesions.
Management of the disease includes treatment of underlying causes sedation and analgesia, maintenance of adequate systemic blood pressure, and ventilator and pharmacologic measures to increase pulmonary vasodilatation, decrease PVR, increase blood and tissue oxygenation and normalize blood PH. If all other treatments fail, ECMO can be used. Currently the therapeutic mainstay for PPHN is optimal lung inflation and selective vasodilatation with (iNO). However iNO is'nt available and not all infants will respond to it. Milrinone is a phosphodiesteras III inhibitor which induces pulmonary vasodilatation by its action through a CAMP mediated signaling pathway.
Magnesium sulfate (MgSO4) is a natural Ca channel blocker that antagonizes Ca ion entry into smooth muscle cell thus promoting vasodilatation. MgSO4 is a safe and cheaper alternative for first line treatment in moderate PPHN and was chosen to be an alternative therapy for PPHN when other conventional treatments fail, are contraindicated or are not available.
During the study, 40 neonates were included and they were divided into two groups: the first group (group I) represented 20 neonates were treated by Milrinone. Whereas the second group (groupII) represented 20 neonates treated by MgSo4.
Our study revealed that good improvement in PAP with two groups with more side effects inMgSo4 group as hypotension.
We noticed that group I treated by Milrinone was elevated PPHN than group II.
In our study the use of milrinone as an adjuvant to conventional therapy was effective when used in neonate with moderate to severe PPHN. Its use was associated with significant improvement of oxygen saturation, ABGs and systolic pulmonary artery pressure. There was no effect on systemic blood pressure and neonates who received milrinone did not become hypotensive. On the other hand, there was a significant drop in heart rate after 8-24 hours.
Other data
| Title | COMPARISON BETWEEN EFFECTIVENESS OF MAGNESIUM SULPHATE VERSUS MILRINONE IN NEONATAL PULMONARY HYPERTE | Other Titles | المقارنـة بين الميلرينون والماغنسيوم سـلفـات في عـلاج ارتفاع الضغط في الشريان الرئوي في الأطفال حديثي الولادة | Authors | Ahmed Maher Soliman Ghaly | Issue Date | 2014 |
Recommend this item
Similar Items from Core Recommender Database
Items in Ain Shams Scholar are protected by copyright, with all rights reserved, unless otherwise indicated.