348 - Iloprost for persistent pulmonary hypertension of the newborn - a systematic review and single-arm meta-analysis.

Thais Iwashita Lages, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto – Universidade de São Paulo, Ribeirao Preto, Sao Paulo, Brazil; Eduardo Antonio de Sousa Orlandin, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil; Felipe Martins Liporaci, Universidade de São Paulo, Ribeirão Preto, Sao Paulo, Brazil; Milena Ramos Tome, universidade federal de campina grande, Fortaleza, Ceara, Brazil

Background: Persistent pulmonary hypertension of the newborn (PPHN) is a severe condition marked by elevated pulmonary vascular resistance and significant morbidity and mortality. The role of iloprost in the setting of PPHN is unknown.

Objective: To assess the rates of mortality and adverse outcomes in patients with PPHN treated with iloprost.

Design/Methods: We systematically searched Pubmed, EMBASE, and Cochrane databases for randomized controlled trials (RCTs) and observational studies including patients with PPHN who received iloprost with or without nitric oxide and reporting rates of mortality and intraventricular hemorrhage (IVH). R software (version 2023.06.1+524; R Foundation, Vienna, Austria) was used to carry out all statistical analyses.

Results: Were included 13 observational studies, comprising a total of 259 preterm and term infants. Mean birth gestational age was 27.3 weeks (range 22-40), and mean birth weight was 2119g (range 448-4290). In all studies, iloprost was initiated predominantly in the first 72 hours of life. PPHN was defined among studies as an oxygenation index > 20-25 and echocardiographic findings compatible with PPHN. The mortality rate was 17.96% (95% CI 9.45% to 27.99%) among patients with PPHN treated with iloprost, with no significant interaction between the subgroups stratified according to concomitant use of inhaled nitric oxide (P for interaction = 0.33). IVH rate was 0.10% (95% CI 0.00% to 1.16%), with no significant interaction between groups (P for interaction = 0.21).

Conclusion(s): Iloprost therapy in the setting of PPHN was associated with a low incidence of IVH. Dedicated randomized trials are warranted to ascertain the role of iloprost in reducing mortality in PPHN.

Mortality
Mortality

IVH
IVH