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APPLICATION OF DOPPLER ECHOCARDIOGRAPHY IN THE TREATMENT OF HYPOXIC PULMONARY HYPERTENSION WITH NITRIC OXIDE INHALATION IN THE NEWBORN INFANTS

Wu L, Huang GY, Lin QS, Sun B and Ning SB

Children's Hospital of Fudan University, Shanghai, China

Objective: To assess the effects of Doppler echocardiography on monitoring pulmonary hypertension during inhalation of nitric oxide (iNO) in the treatment of neonatal hypoxic respiratory failure.

Methods: 22 neonates (2.46± 0.53kg of body weight) with pneumonia, NRDS or PPHN were admitted into NICU in the age of 1-20 days. All patients had respiratory failure in aggressive mechanical ventilation. Doppler echocardiography combined with Color Flow Mapping was utilized to quantitate systolic pressure of pulmonary artery (SPAP) based on tricuspid regurgitation (TR), PDA or VSD shunting, and to examine the cardiac function reflected by left ventricular ejection fraction (LVEF). Systolic blood pressure (SBP) was read when echocardiography was carried out and a ratio of SPAP/SBP was calculated.

Results: The results showed that all patients had PDA with 3 right-to-left, 3 left-to-right and 16 bi-directional shunt. TR was revealed in 18 cases. One patient had also perimembranous VSD with bi-directional shunt. SPAP increased in all patients ranged at the level of 58±7 mmHg prior to iNO and decreased to 43±7 mmHg in 30-120 min, and to 40±10mmHg in 18-24 hr post initiation of iNO at 3-10 ppm respectively (p<0.001). SPAP/SBP was 0.92±0.10 prior to iNO and decreased to 0.70±0.10 in 30-120 min, and to 0.66±0.20 in 18-24 hr post initiation of iNO (p<0.001). However, significant changes were not observed for both LVEF and SBP post initiation of iNO.

Conclusion: Doppler echocardiography is invaluable in determining the indication of iNO and in monitoring the efficacy of iNO. The strategy of iNO is effective and safe in the treatment of pulmonary hypertension due to hypoxia.