inhaled iloprost is used as a therapeutic option for pulmonary hypertension , especially in adults ; however , have been but a few reports on the use of iloprost in neonates and infants . prostacyclin ( pgi2 ) is an arachidonic acid metabolite formed by prostacyclin synthase in the vascular endothelium . its effect on vascular tone is mediated by an increment in adenosine 3':5'-cyclic monophosphate ( camp ) levels and is comparable to that of inhaled nitric oxide ( no ) , which increases the cyclic guanosine monophosphate ( cgmp ) levels . herein we report the use of iloprost in treating pulmonary hypertension in an infant with bronchopulmonary dysplasia ( bpd ) . inhaled iloprost reduced the pulmonary hypertension and improved oxygenation without decreasing the systemic blood pressure . a 5-month - old male infant was brought to the premature baby clinic with severe dyspnea and chest retractions . the infant was born at 26 weeks of gestation via caesarean section because of acute chorioamninitis and placentitis . the birth weight was 800 gm . he received neonatal intensive care due to respiratory distress syndrome and prematurity , during which he developed bpd . he was discharged from the neonatal intensive care unit in stable condition after 4 months . 1 ) . based on echocardiography , the pulmonary pressure was elevated , with a pressure gradient ( tr pg ) of 48 mmhg and there was a severely dilated right ventricle ( rv ) with tricuspid valve regurgitation ( fig . therapeutic strategies were aimed at optimizing respiratory function and alkalinization in order to decrease the pulmonary artery pressure . the initial treatments included respiratory support with high frequency oscillatory ventilation ( hfov ) and sildenafil ( 3 mg / kg / day ) , an oral phosphodiesterase-5 inhibitor ; however , the clinical condition had not improved significantly by the 3rd hospital day . his oxygen requirements progressively increased , persistent cardiomegaly was noted on the chest radiograph , and serial echocardiograms showed pulmonary hypertension , thus the hfov was discontinued . no was not available at our hospital , therefore inhaled iloprost was added with continuous oral sildenafil . we applied iloprost through an aerosolizing circuit and nebulizer for 20 days . with the additional administration of iloprost , serial echocardiograms showed mild elevated pulmonary pressure , with a tr pg of 34 mmhg and a decrease in the size of the rv ( fig . after 23 days , he was discharged with a normal oxygen saturation on room air . pulmonary artery hypertension ( pah ) is a common cardiovascular complication in preterm infants with bpd and is associated with increased morbidity and mortality.1)2 ) pah is characterized by elevation of the pulmonary artery pressure and pulmonary vascular resistance , which can lead to progressive right heart failure and death.3 - 6 ) premature infants with bpd and severe pah are at a high risk of death , particularly during the first 6 months after the diagnosis of pah.7 ) on the basis of advances in vascular biology and known pathogenic mechanisms underlying pah , three general classes of therapeutic agents have been developed and are currently available for the treatment of pah , including prostacyclin analogues ( epoprostenol , treprostinil , and iloprost ) , endothelin receptor antagonists ( bosentan and ambrisentan ) , and phosphodiesterase inhibitors ( sildenafil).5)8)9 ) iloprost is a prostacyclin - analog which is an important mediator of pulmonary vasodilatation . however , few data are available about its use in the critical care of infants . ivy et al.10 ) reported the safety and efficacy of inhaled iloprost in pediatric patients with pah ; the acute pulmonary vasodilator response to inhaled iloprost was equivalent to the effects of inhaled no.10 ) our clinical experience indicates that iloprost is a promising therapy for pulmonary hypertension , especially in situations in which inhaled no is unavailable . future studies are warranted to better define the safety and efficacy of iloprost in comparison with other vasodilator drugs .
pulmonary artery hypertension is a common cardiovascular complication in preterm infants with bronchopulmonary dysplasia which is associated with increased morbidity and mortality . 
 inhaled iloprost is used as a therapeutic option in pulmonary hypertension , especially in adults . 
 there have been but a few reports on the use of iloprost for neonates and infants . 
 we report the case of a 5 month - old - male infant who received neonatal intensive care for 4 months due to respiratory distress syndrome and prematurity , during which he developed bronchopulmonary dysplasia . 
 echocardiography showed severe pulmonary hypertension . 
 the initial treatment included respiratory support with high frequency oscillatory ventilation ( hfov ) ; however , his clinical condition did not improve . 
 inhaled iloprost with sildenafil , an oral phosphodiesterase-5 inhibitor , was thus used . with the administration of iloprost and sildenafil , 
 his condition improved and he was weaned from oxygen . 
 our clinical experience suggests that iloprost is a promising therapy for pulmonary hypertension , especially when inhaled nitric oxide is unavailable .