• Marco Piastra, Daniele De Luca, Maria Pia De Carolis, Alessia Tempera, Eleonora Stival, Francesca Caliandro, Domenico Pietrini, Giorgio Conti, and Gabriella De Rosa.
• Department of Anaesthesiology and Intensive Care, Paediatric Intensive Care Unit, University Hospital A Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
• Pediatr. Pulmonol. 2012 Aug 1; 47 (8): 757-62.

ObjectiveTo describe a series of ex-preterm infants admitted to pediatric intensive care unit due to impending hypoxaemic respiratory failure complicated by pulmonary hypertension (PH) who were treated electively combining noninvasive ventilation (NIV) and nebulized iloprost (nebILO).DesignOpen uncontrolled observational study.SettingPediatric Intensive Care Unit, University Hospital.PatientsTen formerly preterm infants with impending hypoxaemic respiratory failure and PH, of whom eight had moderate to severe bronchopulmonary dysplasia.Measurements And Main ResultsMedian age and body weight were 6.0 (2.75-9.50) months and 4.85 (3.32-7.07) kg, respectively. We observed a significant early oxygenation improvement in terms of PaO(2) /FiO(2) increase (P = 0.001) and respiratory rate reduction (P = 0.01). Hemodynamic also improved, as shown by heart rate (P = 0.002) and pulmonary arterial pressure systolic/systolic systemic pressure (PAPs/SSP) ratio reduction (P = 0.0137). NebILO was successfully weaned in positive response cases: 4 infants were discharged on oral sildenafil. Three patients failed noninvasive modality and needed invasive mechanical ventilation; hypoxic-hypercarbic patients were most likely to fail noninvasive approach. Only one patient requiring invasive ventilation died and surviving babies had a satisfactory 1-month post-discharge follow-up. CONCLUSIONS.: The noninvasive approach combining NIV and nebILO for ex-preterm babies with impending respiratory failure and PH resulted to be feasible and quickly achieved significant oxygenation and hemodynamic improvements.Copyright © 2011 Wiley Periodicals, Inc.

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