CHLORPROMAZINE TREATMENT OF PERSISTENT PULMONARY HYPERTENSION IN THE NEUBORN

The treatment of persistent pulmonary hypertension in the newborn (PPHN) has not been settled yet. Alpha-adrenergic blocking drugs widely used in the treatment of PPHN may exhibit serious side effects. In various hypoxemic states chlorpromazine (CPZ) has been recently reported to improve hypoxia, presumably due to the alpha-adrenergic blocking effect (Larsson et al. 1982). The aim of the present study was to assess the possible therapeutic value of CPZ in PPHN. Criteria for establishing the diagnosis of PPHN were: hypoxemia refractory to CPAP or PEEP ventilation, enhancement of the difference between pre- and postductal PaO2, hyperoxia-hyperventilation test and M-mode echocardiography in differentiating PPHN from congenital heart defects. 13 neonates with PPHN who had PaO2<50 torr at 100% oxygen were studied. CPZ was administered into a peripheral vein or umbilical artery catheter in a dose of 0.5 - 1.0 mg/kg/h As PaO2 began to rise the dosage was gradually lowered to 0.1 mg/kg/h 10 of the 13 patients survived. In 11 neonates the PaO2 increased substantially. Two patients, who developed symptoms of patent ductus arteriosus, were given Indomethacin, and the ductus closed. In conclusion, the use of CPZ in the treatment of PPHN seems to be a promising new approach without unexpected side effects.