Endotracheal instillation of prostacyclin in preterm infants with persistent pulmonary hypertension.

Does endotracheal instilled prostacyclin (epoprostenol) improve oxygenation in preterm infants with persistent pulmonary hypertension? Four preterm infants were studied. Prostacyclin (50 ng x kg(-1)) was injected as an endotracheal bolus. In two patients the prostacyclin bolus was repeated and in one patient prostacyclin was administered continuously. Oxygenation was evaluated through the oxygenation index and the ratio of arterial oxygen tension to the fraction of inspired oxygen. The mean arterial blood pressure was used to evaluate systemic circulation. The oxygenation index (+/-SD) decreased significantly from 39 (+/-13.3) to 7 (+/-2.5) and the ratio of arterial oxygen tension to the fraction of inspired oxygen (+/-SD) increased significantly from 47 (+/-13) to 218 (+/-67), most likely related to a reduction of the pulmonary vascular resistance with a reversal of the extrapulmonary shunting at the ductus arteriosus and atrial level. The blood pressure did not change. All effects were reversed on drug withdrawal. Repeated or continuous endotracheal administration of prostacyclin in three children demonstrated a sustained response without tachyphylaxis, and without overt side-effects. Endotracheal instillation of prostacyclin resulted in an improved oxygenation without systemic vascular repercussions in four preterm infants with persistent pulmonary hypertension. Repeated or continuous administration showed a sustained response and no overt side-effects were noticed.