Why the study?
Does continuous intravenous infusion of nitroglycerin improve hemodynamics in neonates with refractory congestive heart failure or Persistent Fetal Circulation?
Does continuous intravenous infusion of nitroglycerin improve hemodynamics in neonates with refractory congestive heart failure or Persistent Fetal Circulation?
Intravenous nitroglycerin at 2-5 micrograms/kg/min safely improves hemodynamics, including ejection fraction and cardiac output, in neonates with refractory congestive heart failure or persistent fetal circulation.
May support low-dose nitroglycerin in refractory neonatal heart failure; case report leaves open need for controlled trials before practice change.
(1) Continuous intravenous infusion (2-10 micrograms/kg/min) of nitroglycerin (TNG) was administered to 20 neonates consisting of 17 with refractory congestive heart failure and 3 with PFC (Persistent Fetal Circulation). (2) At doses of 2-4 micrograms/kg/min, there were no significant changes in heart rate or systemic blood pressure. (3) At doses of 2-4 micrograms/kg/min, the CVP was significantly reduced and urinary output increased. (4) Echocardiograms revealed a significant decrease in LVS at 4-5 micrograms/kg/min. In addition, the EF and cardiac output were significantly increased at 2-5 micrograms/kg/min. (5) The right ventricle systolic time interval (STI) was reduced significantly at 2 micrograms/kg/min. The left ventricle STI was not reduced below doses of 4 micrograms/kg/min. (6) In the dose range 2-5 micrograms/kg/min, TNG is an effective and safe vasodilator in the treatment of refractory congestive heart failure or PFC in neonates.
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Tamura et al. (1990) studied this question.
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