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Indian Pediatr 2013;50: 1064-1065 |
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Is It Safe to Use Inhaled Iloprost in Infants
With Pulmonary Hypertension ?
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Aysu Türkmen Karaagaç and *Ayse Inci Yildirim
*Pediatric Cardiology, Kartal Koşuyolu Research and
Training Hospital, Denizer cad. Cevizli kavsagı,
No:2 34846 Kartal/Istanbul
Email: [email protected]
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Pulmonary arterial hypertension (PAH) is
a rare disorder characterized by increased pulmonary
arterial pressure and vascular resistance due to the
impaired endothelial wall and smooth muscle functions of the
pulmonary vessels [1,2].
The PAH in children is either idopathic
(IPAH) or associated with congenital heart diseases (CHD),
especially with left to right shunts [3].
In the treatment, nitric oxide,
prostanoids, magnesium sulphate, endothelin receptor
antagonists and phosphodiesterase-5 inhibitors are used.
Prostacyclins vasodilate the pulmonary vessels and prevent
the endothelial cell damage to control PAH [4].
The most common side effects of
prostacyclins is headache, systemic hypotension, allergic
reactions, chest pain, dyspnea, nausea and vomiting [2,4].
The optimum dosage with the minimum side effects is 0.3 ng/kg/min
for the inhalation and 0.6 ng/kg/min. for the intravenous
administration of iloprost (synthetic analog of prostacyclin)
[4].
To evaluate the safety of inhaled
iloprost in infants with PAH, we analyzed its side effects
retrospectively in our pediatric cardiology and
cardiovascular surgery clinic. We evaluated 52 infants (27
females) with PAH-CHD hospitalized for the surgical
correction of their cardiac anomalies in the last year.
Their mean age was 13.5±4.7 months (3-24 months) and the
mean pulmonary arterial pressure (PAP) was 39±11.6 mmHg.
(25-70 mmHg). They received iloprost
inhalation (Ilomedin, Schering AG)
6 times/day at a dosage of 0.3 ng/kg/min for 7-15 days (mean
10.6 ± 2.8 days) preoperatively. Their mean PAP was 28 ±
12.3 mmHg after the iloprost treatment. The difference in
the mean PAP values was statistically significant (P<0.05).
The infants were monitorized during the inhalation. They did
not develop systemic hypotension (mean arterial pressure was
72±8.7 mmHg) and their vital signs were stable.
Among the side effects encountered in the
29 infants (55.7%) during the inhalation, 22 (75.8%) had
rash on the cheeks and around the mouth, 4 (13.7%) had
agitation, 2 (6.8%) had nausea and vomiting just after the
inhalation and 1(3.4%) had bronchospasm. We had to stop the
iloprost treatment only in one infant with bronchospasm
attacks. Symptomatic relief was provided for other symptoms
such as rash, nausea, vomiting and agitation, so these
infants continued the iloprost inhalation. There was no
pathologic change in the blood cell counts, liver and renal
function tests of the infants after the inhaled iloprost
administration.
Inhaled iloprost seems to be a safe and
efficient therapy for the infants with PAH if it is used in
a controlled manner.
References
1. Berger RM, Beghetti M, Humpl T, Raskob
GE, Ivy DD, Jing ZC, et al. Clinical features of
pediatric pulmonary hypertension: a registry study. Lancet.
2012;379:537–46.
2. Saji T, Nakayama T, Matsuura H.
Pulmonary arterial hypertension in pediatric age. Nippon
Rinsho. 2008;66:2193-9.
3. van Loon RL, Roofthooft MT, Hillege
HL, ten Harkel AD, van Osch-Gevers M, Dehloos T, et al.
Pediatric pulmonary hypertension in the Netherlands;
epidemiology and characterization during the period 1991 to
2005. Circulation. 2011;124:1755-64.
4. Hawkins A, Tulloh R. Treatment of pediatric pulmonary
hypertension. Vasc Health Risk Manag. 2009;5:509–24.
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