Sildenafil in the management of neonates with PPHN : a rural regional hospital experience : case report

Abstract

Introduction. Persistent pulmonary hypertension of the newborn (PPHN) can occur as a primary or secondary neonatal emergency and remains a serious management challenge with a high mortality rate. The failure of a rapid fall in pulmonary vascular resistance in the early postnatal period that characterises PPHN can progress into a vicious pulmonary vasoconstrictive cycle if not promptly managed. In the past 5 years sildenafil citrate (Viagra; Pfizer), with its selective pulmonary vasodilator properties, has emerged as a potential treatment modality for PPHN. Objectives and methods. To describe our experience with the use of sildenafil in 2 non-ventilated neonates with moderate to severe PPHN. The patients were managed at Worcester Hospital, a rural regional hospital in the Western Cape, South Africa. Results. In both cases the addition of sildenafil to the treatment regimen resulted in : (i) a significant increase in haemoglobin oxygen saturation as measured by pulse oximetry; (ii) ability to wean the fraction of inspired oxygen; and (iii) avoidance of mechanical ventilation and referral to a tertiary intensive care unit. Conclusion. Sildenafil appears to be beneficial in the treatment of PPHN and its use can be considered in the management of selected cases, even in a resource-limited setting; however, this still needs to be validated by more controlled studies.