Refractory Persistent Pulmonary Hypertension of the Newborn Responsive Only to Neuromuscular Blockade

Abstract

We discuss the case of a premature newborn boy presenting with severe persistent pulmonary hypertension (PPHN) at 48 hours of life in the context of Staphylococcus aureus sepsis. PPHN was refractory to classical treatment (oxygen, control of acid basic balance, sedation, high frequency oscillation ventilation, inhaled nitric oxide and antibiotics). We observed an improvement only after administration of a curare. Despite much progress in the management of this entity, a clear and well defined therapy is still missing and especially when PPHN is refractory to classical treatment. The use of neuromuscular blockers in the treatment of this kind of PPHN has been described and some physiological explanations are likely. Neuromuscular blocking agents are rarely useful to treat PPHN since the introduction of iNO, nevertheless, it might still be a useful rescue therapy in some selected newborns with PPHN refractory to classical treatments.




J Med Cases. 2013;4(5):288-291
doi: https://doi.org/10.4021/jmc1114w