Inhaled nitric oxide and intravenous magnesium sulphate for the treatment of persistent pulmonary hypertension of the newborn

N. Y. Boo, Rohana Jaafar, S. C. Yong, Bilkis Banu Shri Abd. Aziz, F. Yong-Junina

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Introduction: The aim of this study was to compare the response and survival rates of term infants with persistent pulmonary hypertension of the newborn (PPHN) on high frequency oscillatory ventilation (HFOV) treated with either inhaled nitric oxide (iNO) or intravenous magnesium sulphate (MgSO4). Methods: This was a randomised controlled study. The inclusion criteria were infants with respiratory distress, oxygen index equal to or greater than 25 despite HFOV support, and echocardiographic evidence of PPHN. Infants in the MgSO4 group (n is 13) were loaded with MgSO4 200 mg/kg infused over half an hour, followed by continuous infusion at 50-150 mg/kg/hour to attain a serum magnesium level of 5.0-7.0 mmol/L. Infants in the iNO group (n is 12) were administered nitric oxide at an initial concentration of 20 ppm. Analysis was done on an intention-to-treat basis. Results: There was no significant difference in the median age when the vasodilators were commenced (MgSO4 group: 14.0 hours, interquartile range [IQR]: 7.5, 27.0; iNO group: 14.8 hours, IQR: 12.5, 35.3, p is 0.8). There was no significant difference in the proportion of infants who responded primarily to either vasodilator (MgSO4: 23.3%, iNO: 33.3%, p is 1.0). After switching over to iNO following a failed MgSO4 therapy, a significantly higher proportion (9 out of 10) of the non-respondents in the MgSO4 group recovered from PPHN and survived compared to the non-respondents in the iNO group (one out of eight) who switched over to intravenous MgSO4 (p is less than 0.03). Conclusion: Infants who were administered iNO following a failed MgSO4 therapy were associated with a better outcome than those who were administered MgSO4 following a failed iNO therapy.

Original languageEnglish
Pages (from-to)144-150
Number of pages7
JournalSingapore Medical Journal
Volume51
Issue number2
Publication statusPublished - Feb 2010

Fingerprint

Persistent Fetal Circulation Syndrome
Magnesium Sulfate
Nitric Oxide
High-Frequency Ventilation
Therapeutics
Vasodilator Agents
Magnesium
Oxygen

Keywords

  • Inhaled nitric oxide
  • Intravenous magnesium sulphate
  • PPHN

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Inhaled nitric oxide and intravenous magnesium sulphate for the treatment of persistent pulmonary hypertension of the newborn. / Boo, N. Y.; Jaafar, Rohana; Yong, S. C.; Shri Abd. Aziz, Bilkis Banu; Yong-Junina, F.

In: Singapore Medical Journal, Vol. 51, No. 2, 02.2010, p. 144-150.

Research output: Contribution to journalArticle

@article{f1ecc6aa804843e28e5df42cc9e3f8b1,
title = "Inhaled nitric oxide and intravenous magnesium sulphate for the treatment of persistent pulmonary hypertension of the newborn",
abstract = "Introduction: The aim of this study was to compare the response and survival rates of term infants with persistent pulmonary hypertension of the newborn (PPHN) on high frequency oscillatory ventilation (HFOV) treated with either inhaled nitric oxide (iNO) or intravenous magnesium sulphate (MgSO4). Methods: This was a randomised controlled study. The inclusion criteria were infants with respiratory distress, oxygen index equal to or greater than 25 despite HFOV support, and echocardiographic evidence of PPHN. Infants in the MgSO4 group (n is 13) were loaded with MgSO4 200 mg/kg infused over half an hour, followed by continuous infusion at 50-150 mg/kg/hour to attain a serum magnesium level of 5.0-7.0 mmol/L. Infants in the iNO group (n is 12) were administered nitric oxide at an initial concentration of 20 ppm. Analysis was done on an intention-to-treat basis. Results: There was no significant difference in the median age when the vasodilators were commenced (MgSO4 group: 14.0 hours, interquartile range [IQR]: 7.5, 27.0; iNO group: 14.8 hours, IQR: 12.5, 35.3, p is 0.8). There was no significant difference in the proportion of infants who responded primarily to either vasodilator (MgSO4: 23.3{\%}, iNO: 33.3{\%}, p is 1.0). After switching over to iNO following a failed MgSO4 therapy, a significantly higher proportion (9 out of 10) of the non-respondents in the MgSO4 group recovered from PPHN and survived compared to the non-respondents in the iNO group (one out of eight) who switched over to intravenous MgSO4 (p is less than 0.03). Conclusion: Infants who were administered iNO following a failed MgSO4 therapy were associated with a better outcome than those who were administered MgSO4 following a failed iNO therapy.",
keywords = "Inhaled nitric oxide, Intravenous magnesium sulphate, PPHN",
author = "Boo, {N. Y.} and Rohana Jaafar and Yong, {S. C.} and {Shri Abd. Aziz}, {Bilkis Banu} and F. Yong-Junina",
year = "2010",
month = "2",
language = "English",
volume = "51",
pages = "144--150",
journal = "Singapore Medical Journal",
issn = "0037-5675",
publisher = "Singapore Medical Association",
number = "2",

}

TY - JOUR

T1 - Inhaled nitric oxide and intravenous magnesium sulphate for the treatment of persistent pulmonary hypertension of the newborn

AU - Boo, N. Y.

AU - Jaafar, Rohana

AU - Yong, S. C.

AU - Shri Abd. Aziz, Bilkis Banu

AU - Yong-Junina, F.

PY - 2010/2

Y1 - 2010/2

N2 - Introduction: The aim of this study was to compare the response and survival rates of term infants with persistent pulmonary hypertension of the newborn (PPHN) on high frequency oscillatory ventilation (HFOV) treated with either inhaled nitric oxide (iNO) or intravenous magnesium sulphate (MgSO4). Methods: This was a randomised controlled study. The inclusion criteria were infants with respiratory distress, oxygen index equal to or greater than 25 despite HFOV support, and echocardiographic evidence of PPHN. Infants in the MgSO4 group (n is 13) were loaded with MgSO4 200 mg/kg infused over half an hour, followed by continuous infusion at 50-150 mg/kg/hour to attain a serum magnesium level of 5.0-7.0 mmol/L. Infants in the iNO group (n is 12) were administered nitric oxide at an initial concentration of 20 ppm. Analysis was done on an intention-to-treat basis. Results: There was no significant difference in the median age when the vasodilators were commenced (MgSO4 group: 14.0 hours, interquartile range [IQR]: 7.5, 27.0; iNO group: 14.8 hours, IQR: 12.5, 35.3, p is 0.8). There was no significant difference in the proportion of infants who responded primarily to either vasodilator (MgSO4: 23.3%, iNO: 33.3%, p is 1.0). After switching over to iNO following a failed MgSO4 therapy, a significantly higher proportion (9 out of 10) of the non-respondents in the MgSO4 group recovered from PPHN and survived compared to the non-respondents in the iNO group (one out of eight) who switched over to intravenous MgSO4 (p is less than 0.03). Conclusion: Infants who were administered iNO following a failed MgSO4 therapy were associated with a better outcome than those who were administered MgSO4 following a failed iNO therapy.

AB - Introduction: The aim of this study was to compare the response and survival rates of term infants with persistent pulmonary hypertension of the newborn (PPHN) on high frequency oscillatory ventilation (HFOV) treated with either inhaled nitric oxide (iNO) or intravenous magnesium sulphate (MgSO4). Methods: This was a randomised controlled study. The inclusion criteria were infants with respiratory distress, oxygen index equal to or greater than 25 despite HFOV support, and echocardiographic evidence of PPHN. Infants in the MgSO4 group (n is 13) were loaded with MgSO4 200 mg/kg infused over half an hour, followed by continuous infusion at 50-150 mg/kg/hour to attain a serum magnesium level of 5.0-7.0 mmol/L. Infants in the iNO group (n is 12) were administered nitric oxide at an initial concentration of 20 ppm. Analysis was done on an intention-to-treat basis. Results: There was no significant difference in the median age when the vasodilators were commenced (MgSO4 group: 14.0 hours, interquartile range [IQR]: 7.5, 27.0; iNO group: 14.8 hours, IQR: 12.5, 35.3, p is 0.8). There was no significant difference in the proportion of infants who responded primarily to either vasodilator (MgSO4: 23.3%, iNO: 33.3%, p is 1.0). After switching over to iNO following a failed MgSO4 therapy, a significantly higher proportion (9 out of 10) of the non-respondents in the MgSO4 group recovered from PPHN and survived compared to the non-respondents in the iNO group (one out of eight) who switched over to intravenous MgSO4 (p is less than 0.03). Conclusion: Infants who were administered iNO following a failed MgSO4 therapy were associated with a better outcome than those who were administered MgSO4 following a failed iNO therapy.

KW - Inhaled nitric oxide

KW - Intravenous magnesium sulphate

KW - PPHN

UR - http://www.scopus.com/inward/record.url?scp=77951275446&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77951275446&partnerID=8YFLogxK

M3 - Article

C2 - 20358154

AN - SCOPUS:77951275446

VL - 51

SP - 144

EP - 150

JO - Singapore Medical Journal

JF - Singapore Medical Journal

SN - 0037-5675

IS - 2

ER -