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.