Treprostinil Improves Persistent Pulmonary Hypertension Associated with Congenital Diaphragmatic Hernia.
J Pediatr
; 200: 44-49, 2018 09.
Article
en En
| MEDLINE
| ID: mdl-29784517
ABSTRACT
OBJECTIVE:
To evaluate the effect of continuous treprostinil in infants with severe pulmonary hypertension associated with congenital diaphragmatic hernia (CDH) on specific markers of pulmonary hypertension severity and to report the safety and tolerability of treprostinil. STUDYDESIGN:
We conducted a retrospective cohort study of infants with CDH-associated pulmonary hypertension treated with treprostinil from January 2011 to September 2016. Severity of pulmonary hypertension was assessed by echocardiogram and serum B-type natriuretic peptide (BNP) by using time points before initiation and 24 hours, 1 week, and 1 month after treprostinil initiation. Fisher exact tests, Wilcoxon-rank sum tests, and mixed-effects models were used for analysis.RESULTS:
Seventeen patients were treated with treprostinil for a median of 54.5 days (IQR 44.3-110 days). Compared with the concurrent CDH population (n = 147), infants treated with treprostinil were more likely to require extracorporeal support (76.5% vs 25.2%, P < .0001), to have a longer hospital stay (144 vs 60 days, P < .0001), and to need longer mechanical ventilator support (76.5 vs 30.9 days, P < .0001). Following treprostinil initiation, there was a significant reduction in BNP at 1 week (1439 vs 393 pg/mL, P < .01) and 1 month (1439 vs 242 pg/mL, P = .01). Severity of pulmonary hypertension by echocardiogram improved at 1 month (OR 0.14, CI 95% 0.04-0.48, P = .002). Despite these improvements, overall mortality remained high (35%). There were no adverse events related to treprostinil, including no hypotension, hypoxia, or thrombocytopenia.CONCLUSIONS:
In this cohort, treprostinil use was associated with improved severity of pulmonary hypertension assessed by echocardiogram and decreased BNP, with no significant side effects.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Presión Esfenoidal Pulmonar
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Sistema de Registros
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Epoprostenol
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Hernias Diafragmáticas Congénitas
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Hipertensión Pulmonar
Tipo de estudio:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Female
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Humans
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Infant
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Male
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Newborn
Idioma:
En
Revista:
J Pediatr
Año:
2018
Tipo del documento:
Article
País de afiliación:
Panamá