Effect of bosentan therapy in persistent pulmonary hypertension of the newborn
Background: Persistent pulmonary hypertension of the newborn (PPHN) contributes to neonatal hypoxemia and is associated with a high mortality. Some PPHN patients are unresponsive to inhaled nitric oxide (iNO). Bosentan, an oral endothelin-1 receptor antagonist, reduces pulmonary vascular resistance...
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doaj-15ed9255deb540c789ad4522385b06a92020-11-25T03:55:15ZengElsevierPediatrics and Neonatology1875-95722018-02-01591586410.1016/j.pedneo.2017.02.003Effect of bosentan therapy in persistent pulmonary hypertension of the newbornGunlawadee Maneenil0Anucha Thatrimontrichai1Waricha Janjindamai2Supaporn Dissaneevate3Corresponding author. Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanit Road, Hat Yai, Songkhla 90110, Thailand. Fax: +66 7442 9618.; Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, ThailandDepartment of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, ThailandDepartment of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, ThailandDepartment of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, ThailandBackground: Persistent pulmonary hypertension of the newborn (PPHN) contributes to neonatal hypoxemia and is associated with a high mortality. Some PPHN patients are unresponsive to inhaled nitric oxide (iNO). Bosentan, an oral endothelin-1 receptor antagonist, reduces pulmonary vascular resistance and hence may play a role in the treatment of PPHN. Methods: A retrospective medical records review was performed in newborns who received oral bosentan as an adjunctive therapy for treatment of PPHN between January 2013 and February 2016 at the neonatal intensive care unit of Songklanagarind Hospital. The main outcomes were the effect of bosentan on oxygenation and hemodynamic status after commencement of treatment and the safety of bosentan. Results: Forty neonates at a median (IQR) gestation of 38 (36.8–40) weeks and an initial median (IQR) oxygen index (OI) of 29.2 (13.4–40.1) received bosentan therapy. Oral bosentan was commenced at a median (IQR) age of 27 (14.5–40.2) hours and the mean (SD) duration of treatment was 6.2 (3.1) days. The OI, alveolar-arterial oxygen difference (AaDO2) and oxygen saturation (SpO2) improved significantly at 2 h after treatment (p = 0.002, p = 0.01 and p < 0.001, respectively). In 21 (52.5%) neonates who received iNO and bosentan, the median OI (IQR) was 34.2 (29.0–42.6) with a significant decrease of OI at 6 h (p = 0.005) after treatment. In 19 (47.5%) neonates who received bosentan alone, the median OI (IQR) was 13.0 (9.8–30.9) with a significant decrease of OI in 2 h (p = 0.01) after treatment. The blood pressures before and after bosentan treatment were not statistically significantly different. The mortality rate was 12.5% (5/40). Conclusion: Oral bosentan may be a safe and effective treatment to improve oxygenation in neonates with PPHN. Bosentan can be used as an adjuvant therapy with iNO and can be an alternative therapy option in mild-to-moderate PPHN.http://www.sciencedirect.com/science/article/pii/S1875957217304102bosentannewbornpersistent pulmonary hypertension |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Gunlawadee Maneenil Anucha Thatrimontrichai Waricha Janjindamai Supaporn Dissaneevate |
spellingShingle |
Gunlawadee Maneenil Anucha Thatrimontrichai Waricha Janjindamai Supaporn Dissaneevate Effect of bosentan therapy in persistent pulmonary hypertension of the newborn Pediatrics and Neonatology bosentan newborn persistent pulmonary hypertension |
author_facet |
Gunlawadee Maneenil Anucha Thatrimontrichai Waricha Janjindamai Supaporn Dissaneevate |
author_sort |
Gunlawadee Maneenil |
title |
Effect of bosentan therapy in persistent pulmonary hypertension of the newborn |
title_short |
Effect of bosentan therapy in persistent pulmonary hypertension of the newborn |
title_full |
Effect of bosentan therapy in persistent pulmonary hypertension of the newborn |
title_fullStr |
Effect of bosentan therapy in persistent pulmonary hypertension of the newborn |
title_full_unstemmed |
Effect of bosentan therapy in persistent pulmonary hypertension of the newborn |
title_sort |
effect of bosentan therapy in persistent pulmonary hypertension of the newborn |
publisher |
Elsevier |
series |
Pediatrics and Neonatology |
issn |
1875-9572 |
publishDate |
2018-02-01 |
description |
Background: Persistent pulmonary hypertension of the newborn (PPHN) contributes to neonatal hypoxemia and is associated with a high mortality. Some PPHN patients are unresponsive to inhaled nitric oxide (iNO). Bosentan, an oral endothelin-1 receptor antagonist, reduces pulmonary vascular resistance and hence may play a role in the treatment of PPHN. Methods: A retrospective medical records review was performed in newborns who received oral bosentan as an adjunctive therapy for treatment of PPHN between January 2013 and February 2016 at the neonatal intensive care unit of Songklanagarind Hospital. The main outcomes were the effect of bosentan on oxygenation and hemodynamic status after commencement of treatment and the safety of bosentan. Results: Forty neonates at a median (IQR) gestation of 38 (36.8–40) weeks and an initial median (IQR) oxygen index (OI) of 29.2 (13.4–40.1) received bosentan therapy. Oral bosentan was commenced at a median (IQR) age of 27 (14.5–40.2) hours and the mean (SD) duration of treatment was 6.2 (3.1) days. The OI, alveolar-arterial oxygen difference (AaDO2) and oxygen saturation (SpO2) improved significantly at 2 h after treatment (p = 0.002, p = 0.01 and p < 0.001, respectively). In 21 (52.5%) neonates who received iNO and bosentan, the median OI (IQR) was 34.2 (29.0–42.6) with a significant decrease of OI at 6 h (p = 0.005) after treatment. In 19 (47.5%) neonates who received bosentan alone, the median OI (IQR) was 13.0 (9.8–30.9) with a significant decrease of OI in 2 h (p = 0.01) after treatment. The blood pressures before and after bosentan treatment were not statistically significantly different. The mortality rate was 12.5% (5/40). Conclusion: Oral bosentan may be a safe and effective treatment to improve oxygenation in neonates with PPHN. Bosentan can be used as an adjuvant therapy with iNO and can be an alternative therapy option in mild-to-moderate PPHN. |
topic |
bosentan newborn persistent pulmonary hypertension |
url |
http://www.sciencedirect.com/science/article/pii/S1875957217304102 |
work_keys_str_mv |
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