Nebulized iloprost and noninvasive respiratory support for impending hypoxaemic respiratory failure in formerly preterm infants: A case series

Objective To describe a series of ex-preterm infants admitted to pediatric intensive care unit due to impending hypoxaemic respiratory failure complicated by pulmonary hypertension (PH) who were treated electively combining noninvasive ventilation (NIV) and nebulized iloprost (nebILO). Design Open uncontrolled observational study. Setting Pediatric Intensive Care Unit, University Hospital. Patients Ten formerly preterm infants with impending hypoxaemic respiratory failure and PH, of whom eight had moderate to severe bronchopulmonary dysplasia. Measurements and Main Results Median age and body weight were 6.0 (2.759.50) months and 4.85 (3.327.07) kg, respectively. We observed a significant early oxygenation improvement in terms of PaO2/FiO2 increase (P?=?0.001) and respiratory rate reduction (P?=?0.01). Hemodynamic also improved, as shown by heart rate (P?=?0.002) and pulmonary arterial pressure systolic/systolic systemic pressure (PAPs/SSP) ratio reduction (P?=?0.0137). NebILO was successfully weaned in positive response cases: 4 infants were discharged on oral sildenafil. Three patients failed noninvasive modality and needed invasive mechanical ventilation; hypoxichypercarbic patients were most likely to fail noninvasive approach. Only one patient requiring invasive ventilation died and surviving babies had a satisfactory 1-month post-discharge follow-up. Conclusions. The noninvasive approach combining NIV and nebILO for ex-preterm babies with impending respiratory failure and PH resulted to be feasible and quickly achieved significant oxygenation and hemodynamic improvements. Pediatr Pulmonol. 2012. 47:757762. (c) 2011 Wiley Periodicals, Inc.