Hydralazine in infants with persistent hypoxemic respiratory failure

Pediatrics, Pediatric Critical Care Medicine, University of Alberta, Stollery Children's Hospital 3A3.06 Walter C MacKenzie Health Centre, 8440 112 St, Edmonton, Alberta, Canada, T6G 2B7.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 02/2013; 2(2):CD009449. DOI: 10.1002/14651858.CD009449.pub2
Source: PubMed


In premature infants, pulmonary arterial hypertension (PAH) associated with chronic lung disease (CLD) is associated with high mortality rate. With the exception of oxygen supplementation, no specific interventions have been established as an effective treatment for PAH in premature infants with CLD. Vasodilators could be effective treatments to reduce pulmonary arterial pressure, but little has been proven regarding their clinical effectiveness and concern remains regarding adverse effects. This review found no trials of the use of hydralazine for low birth weight infant with PAH related to CLD. However, since hydralazine is inexpensive and potentially beneficial, randomised controlled trials are recommended.

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    ABSTRACT: Current perspectives for management of acute respiratory insufficiency in premature infants with acute respiratory syndrome and the pathology of acute respiratory insufficiency in the preterm infant, including the current therapy modalities on disposition are presented. Since the therapeutical challenge and primary clinical goal are to normalize ventilation ratio and lung perfusion, when respiratory insufficiency occurs, it is very important to introduce the respiratory support as soon possible, in order to reduce development of pulmonary cyanosis and edema, and intrapulmonary or intracardial shunts. A characteristic respiratory instability that reflects through fluctuations in gas exchange and ventilation is often present in premature infants. Adapting the respiratory support on a continuous basis to the infant's needs is challenging and not always effective. Although a large number of ventilation strategies for the neonate are available, there is a need for additional consensus on management of acute respiratory distress syndrome in pediatric population lately redefined by Berlin definition criteria, in order to efficiently apply various modes of respiratory support in daily pediatrician clinical use.
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