Abstract
Pharmacologic therapy directed at selectively lowering pulmonary artery pressure (PAP) in persistent pulmonary hypertension of the newborn (PPHN) has been largely unsuccessful. As an alternative approach, we have modelled PPHN in septic piglets, and achieved selective elevation of systemic blood pressure (BP) while preserving cardiac output (CO).
Piglets (n=4) were anaesthetized, intubated, and ventilated. BP, PAP, and CO were measured directly and continuously. Pulmonary hypertension was induced by intravenous infusion of serotype Ib Group B Streptococci (GBS) @ approximately 5 × 107 organisms/kg/min.
After 30 minutes of GBS infusion, PAP had risen by 225 ± 972 (S.D;), CO fell by 32 ± 7%, (both p < 0.01) and BP fell by 1 ± 6% (p = N.S.). While GBS continued, infusions of Nitroglycerin (NG) @ 16 mcg/kg/min plus Epinephrine (EPI) @ 2 mcg/kg/min were begun. After 1 hour of NG + EPI, BP had risen by 41 ± 18% (p < 0.01), while PAP fell by 3 ± 18% and CO fell by 18 ± 24% (both p = N.S.).
Conclusions: 1) PPHN can be modelled by GBS infusion in piglets. 2) NG + EPI selectively elevated BP without raising PAP in this model. 3) NG + EPI induced selective elevation of systemic BP without significantly decreasing CO. 4) Selective systemic vasoconstriction with preserved CO may be a feasible strategy for human infants with PPHN.
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Meadow, W., Rudinsk, B., Strates, E. et al. 396 SELECTIVE SYSTEMIC VASOCONSTRICTION WITH PRESERVED CARDIAC OUTPUT DURING GBS-INDUCED PULMONARY HYPER TENSION IN PIGLETS: AN ALTERNATIVE APPROACH TO PPHN?. Pediatr Res 19, 176 (1985). https://doi.org/10.1203/00006450-198504000-00426
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DOI: https://doi.org/10.1203/00006450-198504000-00426