Kendall M Lawrence1, Holly L Hedrick2, Heather M Monk3, Lisa Herkert1, Lindsay N Waqar1, Brian D Hanna4, William H Peranteau2, Natalie E Rintoul4, Rachel K Hopper5. 1. Department of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA. 2. Department of Pediatric General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 3. Department of Pharmacy Services, Children's Hospital of Philadelphia, Philadelphia, PA. 4. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA. 5. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA. Electronic address: rhopper@stanford.edu.
Abstract
OBJECTIVE: To evaluate the effect of continuous treprostinil in infants with severe pulmonary hypertension associated with congenital diaphragmatic hernia (CDH) on specific markers of pulmonary hypertension severity and to report the safety and tolerability of treprostinil. STUDY DESIGN: We conducted a retrospective cohort study of infants with CDH-associated pulmonary hypertension treated with treprostinil from January 2011 to September 2016. Severity of pulmonary hypertension was assessed by echocardiogram and serum B-type natriuretic peptide (BNP) by using time points before initiation and 24 hours, 1 week, and 1 month after treprostinil initiation. Fisher exact tests, Wilcoxon-rank sum tests, and mixed-effects models were used for analysis. RESULTS: Seventeen patients were treated with treprostinil for a median of 54.5 days (IQR 44.3-110 days). Compared with the concurrent CDH population (n = 147), infants treated with treprostinil were more likely to require extracorporeal support (76.5% vs 25.2%, P < .0001), to have a longer hospital stay (144 vs 60 days, P < .0001), and to need longer mechanical ventilator support (76.5 vs 30.9 days, P < .0001). Following treprostinil initiation, there was a significant reduction in BNP at 1 week (1439 vs 393 pg/mL, P < .01) and 1 month (1439 vs 242 pg/mL, P = .01). Severity of pulmonary hypertension by echocardiogram improved at 1 month (OR 0.14, CI 95% 0.04-0.48, P = .002). Despite these improvements, overall mortality remained high (35%). There were no adverse events related to treprostinil, including no hypotension, hypoxia, or thrombocytopenia. CONCLUSIONS: In this cohort, treprostinil use was associated with improved severity of pulmonary hypertension assessed by echocardiogram and decreased BNP, with no significant side effects.
OBJECTIVE: To evaluate the effect of continuous treprostinil in infants with severe pulmonary hypertension associated with congenital diaphragmatic hernia (CDH) on specific markers of pulmonary hypertension severity and to report the safety and tolerability of treprostinil. STUDY DESIGN: We conducted a retrospective cohort study of infants with CDH-associated pulmonary hypertension treated with treprostinil from January 2011 to September 2016. Severity of pulmonary hypertension was assessed by echocardiogram and serum B-type natriuretic peptide (BNP) by using time points before initiation and 24 hours, 1 week, and 1 month after treprostinil initiation. Fisher exact tests, Wilcoxon-rank sum tests, and mixed-effects models were used for analysis. RESULTS: Seventeen patients were treated with treprostinil for a median of 54.5 days (IQR 44.3-110 days). Compared with the concurrent CDH population (n = 147), infants treated with treprostinil were more likely to require extracorporeal support (76.5% vs 25.2%, P < .0001), to have a longer hospital stay (144 vs 60 days, P < .0001), and to need longer mechanical ventilator support (76.5 vs 30.9 days, P < .0001). Following treprostinil initiation, there was a significant reduction in BNP at 1 week (1439 vs 393 pg/mL, P < .01) and 1 month (1439 vs 242 pg/mL, P = .01). Severity of pulmonary hypertension by echocardiogram improved at 1 month (OR 0.14, CI 95% 0.04-0.48, P = .002). Despite these improvements, overall mortality remained high (35%). There were no adverse events related to treprostinil, including no hypotension, hypoxia, or thrombocytopenia. CONCLUSIONS: In this cohort, treprostinil use was associated with improved severity of pulmonary hypertension assessed by echocardiogram and decreased BNP, with no significant side effects.
Authors: Augusto Zani; Wendy K Chung; Jan Deprest; Matthew T Harting; Tim Jancelewicz; Shaun M Kunisaki; Neil Patel; Lina Antounians; Pramod S Puligandla; Richard Keijzer Journal: Nat Rev Dis Primers Date: 2022-06-01 Impact factor: 52.329
Authors: Akila B Ramaraj; Samuel E Rice-Townsend; Carrie L Foster; Delphine Yung; Emma O Jackson; Ashley H Ebanks; Rebecca A Stark Journal: Pediatr Surg Int Date: 2022-07-16 Impact factor: 2.003
Authors: Suzan Cochius-den Otter; Jan A Deprest; Laurent Storme; Anne Greenough; Dick Tibboel Journal: Front Pediatr Date: 2022-04-15 Impact factor: 3.569
Authors: Richard H Parrish; Heather Monk Bodenstab; Dustin Carneal; Ryan M Cassity; William E Dager; Sara J Hyland; Jenna K Lovely; Alyssa Pollock; Tracy M Sparkes; Siu-Fun Wong Journal: J Clin Med Date: 2022-09-24 Impact factor: 4.964