Underdeveloped bones and lungs in a newborn
Asked on 07/28/2015

Underdeveloped bones and lungs in a newborn

Milrinone for persistent pulmonary hypertension of the newborn: Plain language summary

Persistent pulmonary hypertension of the newborn (PPHN) is a condition caused by a failure in the systemic and pulmonary circulation to convert from the antenatal circulation pattern to the normal postnatal pattern. Due to persistent high pressure in the pulmonary vessels, less than normal blood flows to the lungs and thus less oxygen reaches the organs of the body. Milrinone may cause the pulmonary vessels to relax and allow for an increased oxygen supply for the body. However, the review found no trials of the use of milrinone for babies with persistent pulmonary hypertension. Research is needed into the effects of milrinone on PPHN.

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Drugs to dissolve a blood clot lodged in the lungs (pulmonary embolism): Plain language summary

A blood clot that lodges in the main artery of the lungs (pulmonary embolism) strains the right side of the heart, affects blood circulation and can be fatal. Patients are also at risk of new blood clots forming (recurrence). With large blood clots (massive pulmonary embolism), restoring blood flow is urgently required. Heparin thins the blood but newer drugs that actively break up the clots (thrombolytics) may act more quickly and be more effective. These newer drugs include streptokinase, urokinase and recombinant tissue?type plasminogen activator. The major complication of treatment is bleeding. The review authors searched the literature and were able to combine data from eight randomized controlled clinical trials. The trials involved 679 adult patients who were in a stable condition and randomly assigned to a thrombolytic agent or heparin. Thrombolytics did not show any benefit over heparin in terms of deaths and recurrence of blood clots. Limited information from only three of the trials showed that they were better at improving blood flow through the lungs. Major bleeding events were similar with both therapies.

The evidence is quite weak and more double?blind trials are needed to show if there is a true benefit of thrombolytic therapy for pulmonary embolism.

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Magnesium sulfate for persistent pulmonary hypertension of the newborn: Plain language summary

The blood pressure in the arteries of the lungs (pulmonary arteries) is normally much lower than the blood pressure in the rest of the body. Before a baby is born the muscle surrounding the pulmonary arteries is tightly constricted resulting in a very high pressure in these arteries. After birth the arteries dilate and the pressure drops. In persistent pulmonary hypertension of the newborn this drop in pulmonary blood pressure, for a variety of reasons, fails to occur.

Magnesium sulfate is able to dilate constricted muscles of the type in the pulmonary arteries. However, its action is not specific and when given via an intravenous infusion, it will act on other muscles in the body including other arteries. This means that even if it were found to be effective in pulmonary hypertension, unwanted actions in other parts of the body might be a problem.

This review found that the use of magnesium sulfate for persistent pulmonary hypertension of the newborn has not been tested by randomized controlled trials. Evidence from uncontrolled studies is extremely limited but since the little evidence that does exist suggests a potential benefit, randomized controlled trials are recommended. 

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Truncus arteriosus: Possible Complications
  • Heart failure
  • High blood pressure in the lungs (pulmonary hypertension) with pulmonary obstructive lung disease

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Computed by Medwhy Algorithms

Source of information:
Reference: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0014624/
Reference: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0012789/
Reference: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0013571/
Reference: http://www.nlm.nih.gov/medlineplus/ency/article/001111.htm

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