Aerosolized iloprost in the treatment of pulmonary hypertension in extremely preterm infants: A pilot study

Background: In premature infants with preterm prolonged rupture of membranes, death after birth is often due to persistent pulmonary hypertension. Patients: Aerosolized iloprost was used to treat pulmonary hypertension due to prolonged preterm rupture of fetal membranes (7-56 days) in four extremely low-birthweight neonates (23-25 weeks' gestation, weight 448-645 g) under spontaneous breathing supported by nasal continuous positive airway pressure. Method: Inhalation dose was 2 mu g/kg b.w. and between 44 and 65 inhalations were performed in each patient starting within the first hour of life over a total of several days. Single inhalations lasted 5 min and were not repeated until 60 min had elapsed. Results: After the first inhalation, the PaO2/FiO(2) mean ratio increased from 65 (range 35-114) to 194 (148-250)mmHg and oxygenation requirements decreased within the next 7 days. Echocardiography similarly showed reduction in pulmonary resistance. We observed no severe side effects on blood pressure or prolonged bleeding time during inhalation. Conclusions: Iloprost inhalation might therefore be an additional treatment for improving oxygenation in cases of persistent pulmonary hypertension in extremely low-birthweight infants under spontaneous breathing. Further randomized clinical studies are required to establish the role of iloprost in this setting.