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Abstract
BackgroundPersistent pulmonary hypertension of the newborn (PPHN) has been known for more than three decades, and lots of advancements have been made regarding its diagnosis and management. However, the exact causes of PPHN and the best treatment strategies remain debatable. This study aimed to compare the effectiveness of sildenafil and bosentan versus sildenafil and beraprost in the management of persistent pulmonary hypertension of the newborn (PPHN).MethodologyThis open-label, non-randomized, quasi-experimental study was conducted at the Department of Pediatric Cardiology and Neonatology, The Children’s Hospital & The Institute of Child Health, Multan, Pakistan, from January 2021 to June 2021. We enrolled a total of 50 newborns (25 in each group) aged <10 days, gestational age above 34 weeks, who presented with respiratory distress and marked hypoxemia (PaO2 < 50 mmHg) as per arterial blood gas (ABG) analysis and confirmed echocardiographic diagnosis of PPHN within 24 hours of admission. A total of 25 cases were given sildenafil and bosentan, while the other 25 cases were given sildenafil and beraprost. Echocardiographic examination was done again after 72 and 120 hours, and the findings were noted. Outcomes were measured in terms of the reduction in tricuspid regurgitation (TR), mortality, and duration of hospital stay.ResultsOf the 50 neonates, 27 (54.0%) were male. Overall, the mean age was calculated to be 3.54 ± 0.7 days. The mean gestational age was 35.0 ± 0.7 weeks. The mode of delivery was cesarean section among 35 (70.0%) neonates. A significantly higher reduction in tricuspid regurgitation after 72 and 120 hours following the initiation of the treatment was observed in the sildenafil plus bosentan group in comparison with the sildenafil plus beraprost group (p < 0.05). No statistically significant difference was observed in terms of the duration of hospitalization between both study groups (p = 0.1776).ConclusionThe combination of sildenafil and bosentan was found to be more effective than sildenafil and beraprost in reducing tricuspid regurgitation after 72 hours, while they have comparable efficacy at 120 hours of treatment in the management of persistent pulmonary hypertension of the newborn.
Highlights
Persistent pulmonary hypertension of the newborn (PPHN) is described as an increase in the pulmonary vascular resistance and right-to-left shunt at the atrial and ductal level accompanying severe hypoxemia [1]
A significantly higher reduction in tricuspid regurgitation after 72 and 120 hours following the initiation of the treatment was observed in the sildenafil plus bosentan group in comparison with the sildenafil plus beraprost group (p < 0.05)
A local study published in 2018 comparing the effectiveness of sildenafil alone versus sildenafil and bosentan in PPHN revealed that tricuspid regurgitation (TR) was significantly lower among newborns using sildenafil plus bosentan (41.66 ± 9.47 mmHg versus 53.30 ± 9.35 mmHg, p < 0.0001) [7]
Summary
Persistent pulmonary hypertension of the newborn (PPHN) is described as an increase in the pulmonary vascular resistance and right-to-left shunt at the atrial and ductal level accompanying severe hypoxemia [1]. An aggressive approach for supporting cardiac functioning and perfusion along with volume and inotropic drugs to improve cardiac output and systemic O2 transportation is essential in PPHN, while the main principle of treating PPHN is selective pulmonary vasodilation [3,4] Pulmonary vasodilators such as magnesium sulfate, sildenafil, bosentan, prostacyclin, and beraprost are some of the most commonly adopted options for the treatment of PPHN [5]. Persistent pulmonary hypertension of the newborn (PPHN) has been known for more than three decades, and lots of advancements have been made regarding its diagnosis and management. This study aimed to compare the effectiveness of sildenafil and bosentan versus sildenafil and beraprost in the management of persistent pulmonary hypertension of the newborn (PPHN)
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