Safety and Tolerability of Continuous Inhaled Iloprost Therapy for Severe Pulmonary Hypertension in Neonates and Infants

Authors

Amit V. Krishnan, Department of Pediatrics (Cardiology), Columbia University Irving Medical Center, New York, NY 10932, USA.
Victoria Freniere, Department of Pharmacy, New York-Presbyterian Hospital, New York, NY 10065, USA.
Rakesh Sahni, Department of Pediatrics (Neonatology), Columbia University Irving Medical Center, New York, NY 10032, USA.
Diana P. Vargas Chaves, Department of Pediatrics (Neonatology), Columbia University Irving Medical Center, New York, NY 10032, USA.
Sankaran S. Krishnan, Department of Pediatrics, New York Medical College, Valhalla, NY 10595, USA.Follow
Dimitrios Savva, Department of Pharmacy, New York-Presbyterian Hospital, New York, NY 10065, USA.
Usha S. Krishnan, Department of Pediatrics (Cardiology), Columbia University Irving Medical Center, New York, NY 10932, USA.Follow

Author Type(s)

Faculty

DOI

10.3390/children11060703

Journal Title

Children

Document Type

Article

Publication Date

6-7-2024

Department

Pediatrics

Abstract

This is a single-center retrospective study to assess the safety and tolerability of continuous inhaled iloprost use as rescue therapy for refractory pulmonary hypertension (PH) in critically ill neonates and infants. A retrospective chart review was performed on 58 infants and data were collected at baseline, 1, 6, 12, 24, 48 and 72 h of iloprost initiation. Primary outcomes were change in heart rate (HR), fraction of inspired oxygen (FiO), mean airway pressures (MAP), blood pressure (BP) and oxygenation index (OI). Secondary outcomes were need for extracorporeal membrane oxygenation (ECMO) and death. 51 patients treated for >6 h were analyzed in 2 age groups, neonate (≤28 days: n = 32) and infant (29-365 days: n = 19). FiO ( < 0.001) and OI ( = 0.01) decreased, while there were no significant changes in MAP, BP and HR. Of the fifteen patients placed on ECMO, seven were bridged off ECMO on iloprost and eight died. Twenty-four out of fifty-one patients (47%) recovered without requiring ECMO, while twelve (23%) died. Iloprost as add-on therapy for refractory PH in critically ill infants in the NICU has an acceptable tolerability and safety profile. Large prospective multicenter studies using iloprost in the neonatal ICU are necessary to validate these results.

Recommended Citation

Krishnan, A. V., Freniere, V., Sahni, R., Vargas Chaves, D. P., Krishnan, S. S., Savva, D., & Krishnan, U. S. (2024). Safety and Tolerability of Continuous Inhaled Iloprost Therapy for Severe Pulmonary Hypertension in Neonates and Infants. Children, 11 (6). https://doi.org/10.3390/children11060703