Treatment of Persistent Pulmonary Hypertension in Neonates With Nebulized Magnesium Sulfate

Inclusion Criteria: * Newborns with documented persistent pulmonary hypertension as confirmed by echocardiography. * Neonates born at ≥ 35 wk. gestation with a birth weight of 2.5-4 kg * Neonates have to be connected to mechanical ventilation with an oxygenation index (OI) \>30 on two occasions at least 15 min apart. * The echocardiogram had to show a predominant right-to-left or bidirectional shunt (through ductus arteriosus and/or foramen oval) and/or tricuspid regurgitant jet with a pressure gradient ≥ 2/3 of the systemic systolic blood pressure. Exclusion Criteria: * Infants of parents who refuse to give informed consent. * Infants of mothers who receive magnesium sulfate within 48 h before labor. * Congenital heart diseases other than patent ductus arteriosus (PDA) and foramen ovale. * Major congenital anomalies, including congenital diaphragmatic hernia and lung hypoplasia. * Prior need for cardiopulmonary resuscitation * Mean arterial blood pressure (MABP) \< 35 mmHg despite therapy with volume infusions and vasoactive inotropes. * Impaired kidney function; and prior administration of pulmonary vasodilators or prior administration of surfactant.