Materials and Methods
We retrospectively analyzed the records of 6 patients (3 late pretem, 3 term) with PPHN treated with inhaled iloprost at neonatal intensive care of University of Health Sciences, Prof. Dr. Cemil Tascıoglu City Hospital, between December 2019 and April 2022. Demographic and clinical features are presented in Table 1. Eligibility criteria for inhaled iloprost therapy are presented in Figure 1. Inhaled iloprost (20 μg/2 mL, Ventavis, Bayer, Leverkusen, Germany) was administered to at a dose of 2-4 mcg, every 1/2-8 hour according to the protocol in Figure 2, by integrating a nebulizer into the ventilator circuit close to humidifier as shown in video 1.
Echocardiography demonstrated a right ­to ­left shunt or a bidirectional shunt through the PDA or PFO, and no structural anomaly in all patients. Immediate echocardiographic confirmation of drop of pulmonary arterial pressure after inhaled iloprost therapy was not available, but was performed during or at the end of the therapy in 5 patients (Table 1).
Milrinone infusion was administered to patient 3 to alleviate the after load, because of very high ventilatory pressures, and sildenafil to patient 5, after rising oxygenation index (OI) due to 4 mic/dose, as adjunctive therapy.
Inhaled iloprost decreased FiO2 and improved oxygen saturation in all patients. Basal oxygenation indexes are seen in Table 1. Sequence of therapies that might affect OI and OI levels during the course of the treatment are seen in Figure 3-8. Inhaled iloprost was escalated to 4 mcg/dose for patient 3 and 5 after initial dose, because of failure to response to 2 mcg/dose. No adverse effects that could be attributed to iloprost were observed.