Tae Hyeong Kim, Song Ee Youn, Sung-Hoon Chung
Kyung Hee University College of Medicine and Kyung Hee University Hospital at Gangdong.
Republic of Korea
Medicine
Medicine 2026; 105:
DOI: 10.1097/MD.0000000000046984
Abstract
Persistent pulmonary hypertension of the newborn (PPHN) has limited options when unresponsive to inhaled nitric oxide (iNO). We evaluated the role of intravenous treprostinil and whether early response classification could inform management. We retrospectively analyzed 114 neonates who had received iNO therapy during the period from 2014 to June 2025. Based on oxygenation index change during the 1st 24 hours after iNO initiation, infants were classified as fast, slow, or non-responders. Treprostinil was used selectively in severe cases; among 32 non-responders, 16 received adjunctive intravenous treprostinil starting at 6 ng/kg/min and titrated to a maximum of 20 ng/kg/min by clinical response. Baseline characteristics and outcomes were compared between treprostinil-exposed and unexposed infants in the overall cohort. In the non-responder subgroup, time to taper iNO to 10 ppm was compared and a multivariable Cox model was fitted. Compared with unexposed infants, the treprostinil-exposed group had lower gestational age, higher initial oxygenation index, and more frequent inotropic support, indicating greater illness severity, yet mortality and extracorporeal membrane oxygenation use were not significantly different between the 2 groups. Among non-responders, oxygenation improved more quickly in treprostinil-exposed infants, who achieved iNO tapering to 10 ppm earlier (P = .005). Treprostinil exposure was independently associated with earlier clinical stabilization in the Cox model (hazard ratio = 4.99, 95% confidence interval: 1.47-16.98, P = .010). No major adverse effects were observed. In neonates with PPHN unresponsive to iNO, intravenous treprostinil was associated with faster improvement in oxygenation and earlier iNO tapering among non-responders, despite greater baseline severity. Classifying early treatment responses could assist in selecting infants who are more likely to benefit from additional therapies.
Category
Class I. Persistent Pulmonary Hypertension of the Newborn
Medical Therapy. Efficacy or Lack of Efficacy
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Fresh (PHresh). Less than 1-2 years since publication
Article Access
Free PDF File or Full Text Article Available Through PubMed or DOI: Yes