Elsevier

The Journal of Pediatrics

Volume 153, Issue 3, September 2008, Pages 345-349
The Journal of Pediatrics

Original article
Pulmonary Circulatory Effects of Norepinephrine in Newborn Infants with Persistent Pulmonary Hypertension

https://doi.org/10.1016/j.jpeds.2008.03.007Get rights and content

Objective

To evaluate the respiratory and the pulmonary circulatory effects of norepinephrine in newborn infants with persistent pulmonary hypertension (PPHN)-induced cardiac dysfunction.

Study design

Inclusion criteria were: 1) Newborn infants >35 weeks gestational age; 2) PPHN treated with inhaled nitric oxide; and 3) symptoms of circulatory failure despite adequate fluid resuscitation. Lung function and pulmonary hemodynamic variables assessed with Doppler echocardiography were recorded prospectively before and after starting norepinephrine.

Results

Eighteen newborns were included (gestational age: 37 ± 3 weeks; birth weight: 2800 ± 700 g). After starting norepinephrine, systemic pressure and left ventricular output increased respectively from 33 ± 4 mm Hg to 49 ± 4 mm Hg and from 172 ± 79 mL/kg/min to 209±90 mL/kg/min (P < .05). Although the mechanical ventilatory variables have not been changed, the post-ductal transcutaneous arterial oxygen saturation increased from 89% ± 1% to 95% ± 4%, whereas the oxygen need decreased from 51% ± 24% to 41% ± 20% (P < .05). The pulmonary/systemic pressure ratio decreased from 0.98 ± 0.1 to 0.87 ± 0.1 (P < .05). Mean left pulmonary artery blood flow velocity increased by 20% (P < .05).

Conclusion

Norepinephrine may improve lung function in newborn infants with PPHN through a decrease in pulmonary/systemic artery pressure ratio and improved cardiac performance.

Section snippets

Methods

This observational prospective study was approved by the institutional research ethics committee of Amiens University Hospital. The study was conducted in the Neonatal Intensive Care Units of Lille's and Amiens' University Hospital, France. Newborn infants eligible for inclusion were: 1) >35 weeks' gestation and <1 month old; 2) admitted in the neonatal intensive care unit between Jan 1, 2005, and Dec 31, 2006; 3) received inhaled NO for severe respiratory failure and PPHN; 4) had symptoms of

Results

Eighteen newborns were included in the study (mean gestational age, 37 ± 3 weeks; mean birth weight, 2800 ± 700 g). The mean Apgar score was 6 ± 3 and 8 ± 3 at 1 and 5 minutes after birth, respectively. Respiratory failure was caused by meconium aspiration syndrome in 2 cases, congenital diaphragmatic hernia in 6 cases, and early onset sepsis in 10 cases. The mean O2 requirement was 51% ± 20% at the entry of the study. Each of the newborn infants required vascular expansion with saline or 10%

Discussion

The purpose of this observational study was to investigate the respiratory and the hemodynamic effects of norepinephrine in newborn infants with PPHN and circulatory failure. Although the mechanical ventilatory settings were not changed, we found that the use of norepinephrine was associated with a significant decrease in the oxygen requirement. Despite a rise in both pulmonary and systemic artery pressure, the PAP/SAP ratio decreased after starting norepinephrine. The increase in the blood

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