Evidence-Based Treatment for a Newborn with Meconium Aspiration Syndrome Combined with Persistent Pulmonary Hypertension_Chinese Journal of Evidence-Based Medicine

Authors：

 HAN Shuping , YU Zhangbin , CHEN Yulin , QIU Yufang , CHENG Jia , SHA Li , WU Danqing , LI Yaqin

Department of Pediatrics, Nanjing Maternal and Child Health Hospital Affiliated to Nanjing Medical University, Nanjing 210004, China;

Corresponding author：

HAN Shuping, Email: shupinghan@njmu.edu.cn

Keywords：

Meconium aspiration syndrome; Persistent pulmonary hypertension of the newborn; Evidence-based treatment

DOI：

10.7507/1672-2531.20090243

Video：

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Objective 　To make an individualized treatment plan concerning a newborn with meconium aspiration syndrome combined with persistent pulmonary hypertension.
Methods 　Based on the clinical questions raised by a newborn with meconium aspiration syndrome combined with persistent pulmonary hypertension, we searched The Cochrane Library (Issue 3, 2009), MEDLINE (1980 to June 2009), ACP Journal Club (1991 to June 2009), and Chinese Journal Fulltext Database (1994 to June 2009) for systematic reviews, randomized controlled trials (RCTs) and case-control studies. The quality of the included studies was assessed.
Results 　A total of 9 RCTs, 1 health economic evaluation, 1 meta analysis, and 2 systematic reviews were considered eligible. The evidence indicated that the use of ECMO in infants of PPHN had shown a decreased risk of death, but not cost-saving from a societal perspective; iNO treatment could improve the PaO2 and resulted in a reduction in the incidence of requirement for ECMO; there were not randomized controlled trials regarding the treatment of PPHN by hyperventilation, high-frequency ventilation, alkali infusion, pulmonary vasodilators (magnesium sulfate, tolazoline, prostaglandin or prostacyclin, milrinone), surfactant therapy; oral sildenafil could lower oxygenation index (OI) and result in a reduction in the incidence of death. The individualized treatment plans of oral sildenafil were developed based on the available evidence, existing conditions of the hospital, and the values of children with families. After 1 month of treatment, the FiO2 returned to normal and symptoms were alleviated.
Conclusion 　The treatment efficacies and the survival rates in meconium aspiration syndrome combined with PPHN have been improved by determining an individualized treatment plan according to evidence-based methods.

Citation： HAN Shuping,YU Zhangbin,CHEN Yulin,QIU Yufang,CHENG Jia,SHA Li,WU Danqing,LI Yaqin. Evidence-Based Treatment for a Newborn with Meconium Aspiration Syndrome Combined with Persistent Pulmonary Hypertension. Chinese Journal of Evidence-Based Medicine, 2009, 09(12): 1339-1342. doi: 10.7507/1672-2531.20090243 Copy

1.	Konduri GG, Kim UO. Advances in the diagnosis and management of persistent pulmonary hypertension of the newborn. Pediatr Clin North Am, 2009, 56(3): 579-600.
2.	Ho JJ, Rasa G. Magnesium sulfate for persistent pulmonary hypertension of the newborn. Cochrane Database Syst Rev, 2007(3): CD005588.
3.	Shah PS, Ohlsson A. Sildenafil for pulmonary hypertension in neonates. Cochrane Database Syst Rev, 2007(3): CD005494.
4.	Oliveira CA, Troster EJ, Pereira CR. Inhaled nitric oxide in the management of persistent pulmonary hypertension of the newborn: a meta-analysis. Rev Hosp Clin Fac Med Sao Paulo, 2000, 55(4): 145-154.
5.	Clark RH, Kueser TJ, Walker MW, et al. Low-dose nitric oxide therapy for persistent pulmonary hypertension of the newborn. Clinical Inhaled Nitric Oxide Research Group. N Engl J Med, 2000, 342(7): 469-474.
6.	Roberts JD Jr, Fineman JR, Morin FC, et al. Inhaled nitric oxide and persistent pulmonary hypertension of the newborn. The Inhaled Nitric Oxide Study Group. N Engl J Med, 1997, 336(9): 605-610.
7.	Wessel DL, Adatia I, Van Marter LJ, et al. Improved oxygenation in a randomized trial of inhaled nitric oxide for persistent pulmonary hypertension of the newborn. Pediatrics, 1997, 100(5): E7.
8.	Davidson D, Barefield ES, Kattwinkel J, et al. Inhaled nitric oxide for the early treatment of persistent pulmonary hypertension of the term newborn: a randomized, double-masked, placebo-controlled, dose-response, multicenter study. The I-NO/PPHN Study Group. Pediatrics, 1998, 101(3 Pt 1): 325-334.
9.	Christou H, Van Marter LJ, Wessel DL, et al. Inhaled nitric oxide reduces the need for extracorporeal membrane oxygenation in infants with persistent pulmonary hypertension of the newborn. Crit Care Med, 2000, 28(11): 3722-3727.
10.	Sadiq HF, Mantych G, Benawra RS, et al. Inhaled nitric oxide in the treatment of moderate persistent pulmonary hypertension of the newborn: a randomized controlled, multicenter trial. J Perinatol, 2003, 23(2): 98-103.
11.	Baquero H, Soliz A, Neira F, et al. Oral sildenafil in infants with persistent pulmonary hypertension of the newborn: a pilot randomized blinded study. Pediatrics, 2006, 117(4): 1077-1083.
12.	Bifano EM, Hakanson DO, Hingre RV, et al. Prospective randomized controlled trial of conventional treatment or transport for ECMO in infants with persistent pulmonary hypertension (PPHN). Pediatr Res, 1992, 31(8): 196A.
13.	O’Rourke PP, Crone RK, Vacanti JP, et al. Extracorporeal membrane oxygenation and conventional medical therapy in neonates with persistent pulmonary hypertension of the newborn: a prospective randomized study. Pediatrics, 1989, 84(6): 957-963.
14.	Lorch SA, Cnaan A, Barnhart K. Cost-effectiveness of inhaled nitric oxide for the management of persistent pulmonary hypertension of the newborn. Pediatrics, 2004, 114(2): 417-426.
15.	杜立中, 魏克伦, 孙眉月. 新生儿持续肺动脉高压诊疗常规. 中华围产医学杂志, 2003, 6(1): 61-62.
16.	Mugford M, Elbourne D, Field D. Extracorporeal membrane oxygenation for severe respiratory failure in newborn infants. Cochrane Database Syst Rev, 2008(3): CD001340.
17.	Frostell C, Fratacci MD, Wain JC, et al. Inhaled nitric oxide. A selective pulmonary vasodilator reversing hypoxic pulmonary vasoconstriction. Circulation, 1991, 83(6): 2038-2047.
18.	Tolsa JF, Cotting J, Sekarski N, et al. Magnesium sulphate as an alternative and safe treatment for severe persistent pulmonary hypertension of the newborn. Arch Dis Child Fetal Neonatal Ed, 1995, 72(3): F184-187.
19.	Abu-Osba YK, Galal O, Manasra K, et al. Treatment of severe persistent pulmonary hypertension of the newborn with magnesium sulphate. Arch Dis Child, 1992, 67(1 Spec No): 31-35.
20.	Young TE. Neofax. 19th ed. Raleigh: Acorn Publishing Inc, 2006: 136-146.

1. Konduri GG, Kim UO. Advances in the diagnosis and management of persistent pulmonary hypertension of the newborn. Pediatr Clin North Am, 2009, 56(3): 579-600.
2. Ho JJ, Rasa G. Magnesium sulfate for persistent pulmonary hypertension of the newborn. Cochrane Database Syst Rev, 2007(3): CD005588.
3. Shah PS, Ohlsson A. Sildenafil for pulmonary hypertension in neonates. Cochrane Database Syst Rev, 2007(3): CD005494.
4. Oliveira CA, Troster EJ, Pereira CR. Inhaled nitric oxide in the management of persistent pulmonary hypertension of the newborn: a meta-analysis. Rev Hosp Clin Fac Med Sao Paulo, 2000, 55(4): 145-154.
5. Clark RH, Kueser TJ, Walker MW, et al. Low-dose nitric oxide therapy for persistent pulmonary hypertension of the newborn. Clinical Inhaled Nitric Oxide Research Group. N Engl J Med, 2000, 342(7): 469-474.
6. Roberts JD Jr, Fineman JR, Morin FC, et al. Inhaled nitric oxide and persistent pulmonary hypertension of the newborn. The Inhaled Nitric Oxide Study Group. N Engl J Med, 1997, 336(9): 605-610.
7. Wessel DL, Adatia I, Van Marter LJ, et al. Improved oxygenation in a randomized trial of inhaled nitric oxide for persistent pulmonary hypertension of the newborn. Pediatrics, 1997, 100(5): E7.
8. Davidson D, Barefield ES, Kattwinkel J, et al. Inhaled nitric oxide for the early treatment of persistent pulmonary hypertension of the term newborn: a randomized, double-masked, placebo-controlled, dose-response, multicenter study. The I-NO/PPHN Study Group. Pediatrics, 1998, 101(3 Pt 1): 325-334.
9. Christou H, Van Marter LJ, Wessel DL, et al. Inhaled nitric oxide reduces the need for extracorporeal membrane oxygenation in infants with persistent pulmonary hypertension of the newborn. Crit Care Med, 2000, 28(11): 3722-3727.
10. Sadiq HF, Mantych G, Benawra RS, et al. Inhaled nitric oxide in the treatment of moderate persistent pulmonary hypertension of the newborn: a randomized controlled, multicenter trial. J Perinatol, 2003, 23(2): 98-103.
11. Baquero H, Soliz A, Neira F, et al. Oral sildenafil in infants with persistent pulmonary hypertension of the newborn: a pilot randomized blinded study. Pediatrics, 2006, 117(4): 1077-1083.
12. Bifano EM, Hakanson DO, Hingre RV, et al. Prospective randomized controlled trial of conventional treatment or transport for ECMO in infants with persistent pulmonary hypertension (PPHN). Pediatr Res, 1992, 31(8): 196A.
13. O’Rourke PP, Crone RK, Vacanti JP, et al. Extracorporeal membrane oxygenation and conventional medical therapy in neonates with persistent pulmonary hypertension of the newborn: a prospective randomized study. Pediatrics, 1989, 84(6): 957-963.
14. Lorch SA, Cnaan A, Barnhart K. Cost-effectiveness of inhaled nitric oxide for the management of persistent pulmonary hypertension of the newborn. Pediatrics, 2004, 114(2): 417-426.
15. 杜立中, 魏克伦, 孙眉月. 新生儿持续肺动脉高压诊疗常规. 中华围产医学杂志, 2003, 6(1): 61-62.
16. Mugford M, Elbourne D, Field D. Extracorporeal membrane oxygenation for severe respiratory failure in newborn infants. Cochrane Database Syst Rev, 2008(3): CD001340.
17. Frostell C, Fratacci MD, Wain JC, et al. Inhaled nitric oxide. A selective pulmonary vasodilator reversing hypoxic pulmonary vasoconstriction. Circulation, 1991, 83(6): 2038-2047.
18. Tolsa JF, Cotting J, Sekarski N, et al. Magnesium sulphate as an alternative and safe treatment for severe persistent pulmonary hypertension of the newborn. Arch Dis Child Fetal Neonatal Ed, 1995, 72(3): F184-187.
19. Abu-Osba YK, Galal O, Manasra K, et al. Treatment of severe persistent pulmonary hypertension of the newborn with magnesium sulphate. Arch Dis Child, 1992, 67(1 Spec No): 31-35.
20. Young TE. Neofax. 19th ed. Raleigh: Acorn Publishing Inc, 2006: 136-146.

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Evidence-Based Treatment for a Newborn with Meconium Aspiration Syndrome Combined with Persistent Pulmonary Hypertension

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