Persistent Pulmonary Hypertension of the Newborn - Mattel ...

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It is 4 AM in the morning -------You attend the delivery of M.L. at 40 weeks’ gestation. He iscovered with thick meconium. Endotracheal suctioning producesthick meconium from the trachea.‣The infant receives assisted ventilation and surfactant‣Inhaled nitric oxide is started at an OI of 15‣Echocardiogram on DOL 2 shows severe pulmonaryhypertension (PPHN)‣Cranial sonography shows parenchymal blood‣The OI is now 40WHAT ARE YOU GOING TO DO?
Page 8 and 9: Beyond “NO” - Yes, Yes, Yes ---
Page 10 and 11: Off Label Drug Use• Off-label use
Page 12 and 13: Off Label Drug Use• Should we acc
Page 14: Beyond NOToxic MoleculeLife Threate
Page 17 and 18: SELECTIVITYNO - Molecule of the 199
Page 20 and 21: Sildenafil for PulmonaryHypertensio
Page 22 and 23: Intravenous Sildenafil in PPHNStein
Page 24 and 25: PDE5 Inhibitor - Sildenafil• In P
Page 26 and 27: Regulation of Pulmonary Vascular To
Page 28 and 29: Increased PDE3 activity in resistan
Page 30 and 31: 2005,Danhaive2006,Bassler,Kirpalani
Page 32: Endothelin PathwayppET-1ET-AET-1ET-
Page 37 and 38: Evidence in Neonates - PPHNSood, 20
Page 39 and 40: PGI 2 in the Treatment of PAH• IV
Page 41 and 42: “Old Wine in New Bottles”Non-se
Page 43 and 44: SPV - Inhaled VasodilatorsInactivat
Page 45 and 46: Studies of Inhaled Prostaglandins i
Page 47 and 48: Is IPGE 1 Efficacious?
Page 49 and 50: Phase I Trial: Change in P a O 2Δ
Page 51 and 52: Is IPGE 1 Safe?
Page 53 and 54:
Animal Toxicity Studies:• Ten mec
Page 55 and 56:
Is IPGE 1 Stable Upon Aerosolizatio
Page 57 and 58:
Stability - LC-MSPGE 1 500 μg/ml e
Page 59 and 60:
Emitted DoseSood et al, Pharm Res,
Page 61 and 62:
Aerosol Particle Size DistributionA
Page 63 and 64:
PPHNCongenital Heart diseasePiglets
Page 65 and 66:
Is Aerosol Generated by the MiniHea
Page 67 and 68:
Aerosol Delivery Assessed by MRI•
Page 69 and 70:
Aerosol Delivery Assessed by MRI35C
Page 71 and 72:
Bob Galli, RRTSood, 2012
Page 73 and 74:
Pilot Randomized Clinical Trial ofI
Page 75 and 76:
Progress• Recruitment halted afte
Page 78 and 79:
Challenges: RCTs in PPHN• Alterna
Page 80:
PGE 1 or PGE 2 ?PGE1:•stimulates
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Persistent Pulmonary Hypertension of the Newborn - Mattel ...

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