Treatment of severe persistent pulmonary hypertension of the newborn with magnesium sulphate.

Y K Abu-Osba, O Galal, K Manasra, A Rejjal

Paediatric Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia.

Eight of nine newborn infants with severe persistent pulmonary hypertension of the newborn (PPHN), and a predicted mortality of 100%, and one infant with a predicted mortality greater than 94% based on alveolar-arterial oxygen tension difference [A-a)DO2) were treated with magnesium sulphate (MgSO4) as a life saving therapy after they failed to improve with conventional treatment. Magnesium at high serum concentrations decreases pulmonary pressures and is a muscle relaxant and sedative. Diluted MgSO4.7H2O solution (200 mg/kg) was given intravenously over 20-30 minutes. No changes in the treatment were made after MgSO4. Mean serum magnesium concentration was maintained between 2.88 and 5.67 mmol/l by continuous intravenous infusion (six infants). Baseline arterial oxygen tension (PaO2) and haemoglobin oxygen saturation had mean (SD) values of 4.66 (1.8) kPa and 60.4 (29.7)% respectively, which started to increase one hour after MgSO4 infusion, and increased significantly at six hours to 12.04 (7.07) kPa and 91.8 (10.88)% respectively. Arterial carbon dioxide tension (PaCO2) decreased and pH increased significantly after one hour compared with the baseline value. PaO2 increases are probably secondary to a decrease in pulmonary vascular resistance and pressure, decrease in a right to left shunt, better ventilation:perfusion ratio, and PaCO2 decrease and pH rise. Seven infants survived (77.8%). These results demonstrate the beneficial effect of magnesium in the management of PPHN when other accepted treatment fails, is contraindicated, or not available.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Raimondi, F., Migliaro, F., Capasso, L., Ausanio, G., Bisceglia, M., Giliberti, P., Messina, F., Salvia, G., Paludetto, R. (2008). Intravenous Magnesium Sulphate vs. Inhaled Nitric Oxide for Moderate, Persistent Pulmonary Hypertension of the Newborn. A Multicentre, Retrospective Study. J Trop Pediatr 54: 196-199 [Abstract] [Full Text]  
• Tolsa, J.-F., Gao, Y., Raj, J. U. (1999). Developmental change in magnesium sulfate-induced relaxation of rabbit pulmonary arteries. J. Appl. Physiol. 87: 1589-1594 [Abstract] [Full Text]  
• Al-Halees, Z., Afrane, B., El-Barbary, M., Fullerton, D. A., McIntyre, R. C. Jr (1997). Magnesium sulfate to facilitate weaning of nitric oxide in pulmonary hypertension.. Ann. Thorac. Surg. 63: 298-299 [Full Text]  
• Bardicef, M., Bardicef, O., Sorokin, Y., Altura, B. M., Altura, B. T., Resnick, L. M. (1996). Perinatal Cellular Ion Metabolism: 31P-Nuclear Magnetic Resonance Spectroscopic Analysis of Intracellular Free Magnesium and pH in Maternal and Cord Blood Erythrocytes. Reproductive Sciences 3: 66-70 [Abstract]