Oral Sildenafil therapy in neonates with pulmonary hypertension of persistent fetal circulation (PPHN) and also of congenital diaphragmatic hernia (CDH)

PPHN has a high mortality, especially in cases with CDH, with main modalities of treatment including assisted ventilation and use of inhaled nitric oxide (NO) which is not generally available. Studies showed the role of sildenafil in improving oxygenation and lowering mortality and especially where No is not available. Objective: to show our experience with oral sildenafil in PPHN and also in cases with CDH Method: The charts of 20 neonates with PPHN and 7 with CDH admitted in NICUs of hospitals in Shiraz, Iran, from March 2012 to March 2016, who received sildenafil were reviewed.Results: 20 neonates with PPHN (55%) female), and 7 with CDH (57.1%) females) were included. Saturation of oxygen before using sildenafil was75.8%±11.5,(50-92%).10(50%) of PPHN and 7(100%)of CDH group needed ventilator with FIO2 79.5%±24.9(30-100%).The dose of sildenafil was 1.8±1.7 mg/kg/day administered for 9.7±8.1(1-41) days .Duration of hospitalization was13.7±12.8(3-56)days. Saturation of O2 after treatment with sildenafil was 89%±20.2 in PPHN and59%±33.12 in CDH group. In 17(85%) of PPHN and 2(28.6%) of CDH oxygen could be discontinued. 9(75%) of PPHN and 2(28.6%) of CDH could be weaned from ventilator. In PPHN group, 17(85%) and 2(28.6%) of CDH group survived. Overall response to sildenafil was assessed based on: increasing O2 saturation, weaning from ventilator or at least decreasing FIO2 and survival was seen in 17(85%) of PPHN, and 2(28.6%) of CDH group.Conclusion: Treatment of pulmonary hypertension of neonates with persistent fetal circulation and even in more severe forms of it as in CDH with sildenafil, especially in areas with no NO resources, is promising.

کلیدواژه ها:

pulmonary ، hypertension ، congenital diaphragmatic hernia