Case 1
A male neonate from the first pregnancy complicated with gestational
hypertension and premature rupture of membranes (amniotic fluid release
23 hours before labor) was delivered vaginally at 35 weeks of gestation,
with a birth weight of 2530 g. The neonate was diagnosed with pulmonary
hypertension associated with RDS and congenital pneumonia.
The signs of progressive respiratory failure have been observed starting
at 10 min after birth. The changes observed in lung ultrasonography
corresponded to grade 1 respiratory distress syndrome (RDS).
Echocardiography demonstrated bilateral flow through the DA, along with
tricuspid regurgitation. Laboratory tests revealed elevated levels of
inflammatory markers. Empirical combination antibiotic therapy with
ampicillin and gentamycin was started, along with the infusion of 20%
magnesium sulfate (4-12 hours of age) and surfactant (Curosurf). Given
the lack of an adequate clinical response and echocardiographic evidence
of progressive PPHN, a loading dose of milrinone has been administered
(25 µg/kg for 15 min, followed by 0.5 µg/kg/min). Due to a short-term
decrease in arterial pressure, the dose of milrinone was tapered down to
0.25 µg/kg/min. Considering a deterioration of echocardiographic indices
after an attempt to withdraw milrinone at approximately 35 hours of the
treatment (as recommended by the manufacturer), a decision to continue
the therapy for a total of 62 hours has been made. The treatment
eventually contributed to the improvement of the echocardiographic
indices (reversion of flow through the DA and regression of tricuspid
regurgitation) and a substantial decrease in the respiratory effort so
that the patient could be extubated at approximately 84 hours of age.
Neither disorders of hemostasis nor echoencephalographic abnormalities
were observed throughout the treatment.