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  • Title: Adenosine infusion for the management of persistent pulmonary hypertension of the newborn.
    Author: Ng C, Franklin O, Vaidya M, Pierce C, Petros A.
    Journal: Pediatr Crit Care Med; 2004 Jan; 5(1):10-3. PubMed ID: 14697102.
    Abstract:
    OBJECTIVE: To determine the effect of adenosine for the management of persistent pulmonary hypertension of the newborn. DESIGN: Prospective, observational case series report. SETTING: A single, tertiary referral neonatal intensive care unit. PATIENTS: Nine neonates with persistent pulmonary hypertension of the newborn requiring mechanical ventilation and inhaled nitric oxide at 20 parts per million. INTERVENTIONS: A continuous intravenous infusion of adenosine at 50 microg/kg/min. MEASUREMENTS AND MAIN RESULTS: Peripheral arterial oxygen saturation, arterial oxygen tension, invasive systemic arterial blood pressure, and pulmonary arterial pressure, estimated using echocardiography, were recorded. There was a significant improvement in arterial oxygenation tension in six of nine neonates who responded to adenosine: PaO2 increased from 66.8 (range, 47-70.5) torr (8.8 kPa) to 73.5 (range, 58.5-94.2) (p=.02) and pulmonary arterial pressure decreased significantly from 63 (range, 42.5-64.0) to 43.5 (range, 32.75-49) mm Hg (p=.002). The pulmonary to systemic mean artery pressure ratio fell from 1.27 (range, 0.88-1.5) to 0.81 (range, 0.64-0.84) (p=.002). Three neonates did not respond to adenosine infusion. CONCLUSIONS: The use of adenosine infusion in combination with inhaled nitric oxide may be a potentially valuable therapeutic option for the treatment of pulmonary hypertension of the newborn. Neonates with irreversible lung pathology may not respond to adenosine infusion.
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