Neonatal Intensive Care Drug Manual

A single RCT enrolling infants with severe respiratory distress, an oxygen index ≥25 despite HFOV support, and echocardiographic evidence of PPHN assessed the effect of MgSO4 group 200 mg/kg infused over half an hour with maintenance 50-150 mg/kg/hour to attain a serum magnesium level of 5.0-7.0 mmol versus iNO group at initial concentration of 20 ppm with crossover if no response. There was no difference in the proportion of infants who responded primarily to either vasodilator (MgSO4 23.3% versus iNO 33.3%, p=1.0). Of the non-responders, 9 of 10 in the HFOV + IV MgSO4 group versus 8 / 12 HFOV + iNO group responded. There was a significant difference in mortality, with 8 of 13 (62%) HFOV + IV MgSO4 group versus 2 of 12 (17%) HFOV + iNO group alive at discharge (p=0.004). Infants who were administered iNO following failed MgSO4 therapy were associated with a better outcome than those who were administered MgSO4 following failed iNO therapy. Several small case series have reported that 37 of 42 infants with severe PPHN treated with MgSO4 responded and survived to discharge.[1-4] Conclusion: The role of MgSO4 in the management of PPHN is unclear. Further trials are required. (LOE II, GOR D)