Comparative study between nebulized and intravenous magnesium sulfate for treatment of persistent pulmonary hypertension in neonates

Background Persistent pulmonary hypertension of the newborn (PPHN) is a life-threatening condition resulting from elevated pulmonary vascular resistance, causing severe hypoxemia. Magnesium sulfate (MgSO 4 ) is a potent vasodilator used in PPHN treatment, but its intravenous administration can cause systemic side effects. This study aims to compare the effects of nebulized and intravenous MgSO 4 on oxygenation and hemodynamic parameters in neonates with severe PPHN. Methods This non-randomized controlled study was conducted on 40 mechanically ventilated neonates with severe PPHN at Benha University Hospitals. Neonates were divided into two groups: one received nebulized MgSO 4 (NebMag, n = 20) and the other intravenous MgSO 4 (IVMag, n = 20). Primary outcome was the change in Oxygenation Index (OI) at 12 and 24 hours. Secondary outcomes included changes in mean arterial pressure (MABP), serum magnesium levels, and vasoactive inotropic score (VIS). Results Both groups showed improvements in oxygenation and ventilatory parameters. However, after 24 hours, the NebMag group had significantly lower OI (19.75 ± 2.9 vs 22.1 ± 2.19, p = 0.032) and higher PaO 2 (69.45 ± 7.56 mmHg vs 60.75 ± 5.9 mmHg, p = 0.008). MABP was significantly higher and VIS was lower in the NebMag group at all time points. Serum magnesium levels were significantly lower in the NebMag group at 12 hours (3.6 ± 0.18 vs 1.2 ± 0.17 mmol/L, p < 0.001). Conclusion Nebulized MgSO 4 may offer a safer alternative to intravenous administration, providing effective pulmonary vasodilation with fewer systemic side effects in neonates with PPHN.