pancuronium and Persistent-Fetal-Circulation-Syndrome

The diagnosis and management of persistent pulmonary hypertension of the newborn remains controversial. A national survey was performed to analyze recent trends in the incidence, diagnosis, management, and survival of patients with persistent pulmonary hypertension of the neonate. Sixty-six institutions from all geographical regions responded. The overall admission incidence was 3.9% +/- 2.6%. Secondary persistent pulmonary hypertension of the neonate was more common than primary. Unexplained hypoxemia, ductal level right-to-left shunting, echocardiography, and a positive response to hyperventilation were all used frequently (in at least 79% of institutions) to diagnose persistent pulmonary hypertension of the neonate. The majority of institutions considered a positive response to hyperventilation to be determined by an increase of PaO2 by 30 mm Hg with a concomitant decrease in PaCO2 to 25 mm Hg. Approximately 70% of institutions use varying ventilator techniques (ie, with or without hyperventilation), but the majority use hyperventilation predominantly. Almost all (greater than 90%) institutions used muscle paralytic agents and pulmonary vasodilators. Tolazoline was the first choice of pulmonary vasodilator therapy. The overall survival rate of persistent pulmonary hypertension of the newborn was 77.4% +/- 13.4%. Survival rate did not differ between different geographic areas of the country. There was a trend noted for improved survival with less use of muscle paralyzing agents. Yet despite varying treatment protocols, survival rates are improving.

Topics: Carbon Dioxide; Echocardiography; Extracorporeal Membrane Oxygenation; Humans; Incidence; Infant, Newborn; Oxygen; Pancuronium; Persistent Fetal Circulation Syndrome; Respiration, Artificial; Survival Rate; United States

Nursing care for PPHN can make the difference between a smoothly controlled hospital course and a disorganized and stressful one. The authors outline a method for coordinating the baby's care, the lines and monitors, ancillary services, and pharmacologic treatment while working closely with the physician and caring for the parents.

Topics: Dopamine; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Intermittent Positive-Pressure Breathing; Intermittent Positive-Pressure Ventilation; Pancuronium; Persistent Fetal Circulation Syndrome; Tolazoline