Michael M. Zayek

INHALED NITRIC OXIDE AND PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN

Background Persistent pulmonary hypertension of the newborn causes systemic arterial hypoxemia because of increased pulmonary vascular resistance and right-to-left shunting of deoxygenated blood. Inhaled nitric oxide decreases pulmonary vascular resistance in newborns. We studied whether inhaled nitric oxide decreases severe hypoxemia in infants with persistent pulmonary hypertension. Methods In a prospective, multicenter study, 58 full-term infants with severe hypoxemia and persistent pulmonary hypertension were randomly assigned to breathe either a control gas (nitrogen) or nitric oxide (80 parts per million), mixed with oxygen from a ventilator. If oxygenation increased after 20 minutes and systemic blood pressure did not decrease, the treatment was considered successful and was continued at lower concentrations. Otherwise, it was discontinued and alternative therapies, including extracorporeal membrane oxygenation, were used. Results Inhaled nitric oxide successfully doubled systemic oxygenation in 16 of 30 infants (53 percent), whereas conventional therapy without inhaled nitric oxide increased oxygenation in only 2 of 28 infants (7 percent). Long-term therapy with inhaled nitric oxide sustained systemic oxygenation in 75 percent of the infants who had initial improvement. Extracorporeal membrane oxygenation was required in 71 percent of the control group and 40 percent of the nitric oxide group (P=0.02). The number of deaths was similar in the two groups. Inhaled nitric oxide did not cause systemic hypotension or increase methemoglobin levels. Conclusions Inhaled nitric oxide improves systemic oxygenation in infants with persistent pulmonary hypertension and may reduce the need for more invasive treatments.

Respiratory Failure Secondary to Barotrauma Is Effectively Treated by Exogenous Surfactant or Bronchoalveolar Lavage with Dilute Surfactant

Respiratory Failure Secondary to Barotrauma Is Effectively Treated by Exogenous Surfactant or Bronchoalveolar Lavage with Dilute Surfactant

Comparison of the Pharmacoeconomics of Calfactant and Poractant Alfa in Surfactant Replacement Therapy

OBJECTIVE To compare the pharmacy costs of calfactant (Infasurf, ONY, Inc.) and poractant alfa (Curosurf, Chiesi USA, Inc., Cary, NC). METHODS The University of South Alabama Childrens and Womens Hospital switched from calfactant to poractant alfa in 2013 and back to calfactant in 2015. Retrospectively, we used deidentified data from pharmacy records that provided type of surfactant administered, gestational age, birth weight, and number of doses on each patient. We examined differences in the number of doses by gestational ages and the differences in costs by birth weight cohorts because cost per dose is based on weight. RESULTS There were 762 patients who received calfactant and 432 patients who received poractant alfa. The average number of doses required per patient was 1.6 administrations for calfactant-treated patients and 1.7 administrations for poractant alfa-treated patients, p = 0.03. A higher percentage of calfactant patients needed only 1 dose (53%) than poractant alfa patients (47%). The distribution of the number of doses for calfactant-treated patients was significantly lower than for the poractant alfa-patients, p < 0.001. Gestational age had no consistent effect on the number of doses required for either calfactant or poractant alfa. Per patient cost was higher for poractant alfa than for calfactant in all birth weight cohorts. Average per patient cost was

Dopamine May Not Improve Cerebral Blood Flow after Cardiac Depression Secondary to Intestinal Ischemia-Reperfusion Injury

1160.62 for poractant alfa, 38% higher than the average per patient cost for calfactant (

Pulmonary Administration of Prostacyclin (PGI2) during Partial Liquid Ventilation (PLV) in an Animal Model of Pulmonary Hypertension (PHT) |[dagger]| 1662

838.34). Using poractant alfa for 22 months is estimated to have cost

Inhaled Nitric Oxide (iNO) and Inhaled Prostacyclin (iPGI 2 ) in an Animal Model of Pulmonary Hypertension (PHT) : Compared Efficacy and Synergy † 1661

202,732.75 more than it would have cost if the hospital had continued using calfactant. CONCLUSION Our experience showed a strong pharmacoeconomic advantage for the use of calfactant compared to the use of poractant alfa because of similar average dosing and lower per patient drug costs.

INDOMETHACIN (IND) DOES NOT BLUNT THE RESPONSE TO INHALED NITRIC OXIDE (iNO) THERAPY IN PIGLETS WITH OLEIC ACID LUNG INJURY (OALI). † 1120

Dopamine May Not Improve Cerebral Blood Flow after Cardiac Depression Secondary to Intestinal Ischemia-Reperfusion Injury

The limit of viability: a single regional unit's experience.

Pulmonary Administration of Prostacyclin (PGI 2 ) during Partial Liquid Ventilation (PLV) in an Animal Model of Pulmonary Hypertension (PHT) † 1662

INHALED NITRIC OXIDE GAS IMPROVES OXYGENATION IN PPHN. • 1430

Inhaled Nitric Oxide (iNO) and Inhaled Prostacyclin (iPGI 2 ) in an Animal Model of Pulmonary Hypertension (PHT) : Compared Efficacy and Synergy † 1661

A Single Regional Unit's Experience

INDOMETHACIN (IND) DOES NOT BLUNT THE RESPONSE TO INHALED NITRIC OXIDE (iNO) THERAPY IN PIGLETS WITH OLEIC ACID LUNG INJURY (OALI). † 1120