The outcome of oral sildenafil therapy on persistent pulmonary hypertension of the newborn with respiratory distress

Abstract

Background Persistent pulmonary hypertension (PPHN) is defined as failure of normal pulmonary vascular adaptation at or soon after birth, resulting in a persistent high pulmonary vascular resistance, which leads to diminished pulmonary blood flow and shunting of unoxygenated blood into systemic circulation through an opened foramen ovale and/or the ductus arteriosus. The prevalence of this syndrome is about 1.9/1000 in the population of neonates born at term. Objective The aim was to evaluate the efficacy and safety of oral sildenafil in the treatment of PPHN. Patients and methods This prospective interventional study was conducted on 50 neonates who were of more than or equal to 37 weeks gestational age and less than 3 days old and were diagnosed as PPHN by echocardiogram and had an oxygenation index (OI) more than or equal to 20. All included cases were given oral sildenafil as per the study protocol with a starting dose of 0.5–2 mg/kg/dose. OI, oxygen saturation, alveolar arterial oxygen gradient, and mean airway pressure were monitored serially. Results This study showed a significant decrease in OI after 30 min of starting treatment and after 24 h of treatment in the studied cases 16.1±1.7 (P=0.010); also, there was a significant decrease in ESPAPͷ after treatment estimated by ECHO from mean 49.4±5,9 to 42.5±5.7 (P Conclusion Oral sildenafil may be of benefit in improving oxygenation in infants with PPHN as it can effectively improve OI and reduce right ventricular systolic pressure.