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      Transitioning From Intravenous to Subcutaneous Prostacyclin Therapy in Neonates With Severe Pulmonary Hypertension

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          Abstract

          This article aims to present our neonatal intensive care unit experience transitioning from intravenous epoprostenol to IV and subcutaneous treprostinil in patients with persistent pulmonary hypertension of the neonate. This was a retrospective chart review at an academic teaching hospital. Neonates with a diagnosis of persistent pulmonary hypertension of the neonate (PPHN) who were started on IV prostacyclin therapy while admitted to the NICU between August 2017 and October 2019 were included. Of the 5 patients included, gestational ages ranged from 24 to 38 weeks. All patients were treated with inhaled nitric oxide and sildenafil before being initiated on IV or SQ prostacyclin therapy. Intravenous epoprostenol dosing was initiated at 1 ng/kg/min and was increased by 1 ng/kg/min every 12 hours until the provider was satisfied with the clinical response. Once the dose was stable for a few days epoprostenol was transitioned to IV treprostinil using double the last epoprostenol dose. A few days later infants were switched to SQ treprostinil using the same dose by stopping the IV infusion and starting the SQ infusion. All patients survived to hospital discharge and were sent home on SQ treprostinil. Minimal adverse effects were seen; patients experienced some slight hypotension, tachycardia, and diarrhea. Severe pulmonary hypertension is a common occurrence and a significant cause of mortality in the NICU. Our patients demonstrate that IV and SQ prostacyclin therapy is a therapeutic option for PPHN. Additionally, rapid high-dose transition from IV epoprostenol to IV treprostinil and then to SQ treprostinil is well tolerated in neonates, with minimal adverse effects.

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          Author and article information

          Journal
          J Pediatr Pharmacol Ther
          J Pediatr Pharmacol Ther
          jppt
          The Journal of Pediatric Pharmacology and Therapeutics : JPPT
          Pediatric Pharmacy Advocacy Group
          1551-6776
          2331-348X
          2020
          : 25
          : 7
          : 647-653
          Author notes

          Department of Pharmacy (MNT, JJR), St. Joseph's Hospital and Medical Center – Dignity Health, Phoenix, AZ; Neonatology (VM), Mednax/NAL, Phoenix, AZ; Pulmonology Critical Care (JF), Arizona Pulmonary Specialists, Phoenix, AZ

          Correspondence Meghan N. Turbenson, PharmD; meghan.turbenson@ 123456dignityhealth.org
          Article
          PMC7541031 PMC7541031 7541031 i1551-6776-25-7-647
          10.5863/1551-6776-25.7.647
          7541031
          33041721
          f9f19106-0c84-4b1e-a71d-bda6b2b0aa27
          Copyright Pediatric Pharmacy Association. All rights reserved. For permissions, email: mhelms@pediatricpharmacy.org 2020
          History
          : 12 March 2020
          Page count
          Pages: 7
          Categories
          Case Reports

          pulmonary hypertension,neonatal intensive care unit,prostacyclin,congenital diaphragmatic hernia,epoprostenol,treprostinil

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