The use of bosentan and sildenafil as rescue therapy in persistent pulmonary hypertension of the newborn: A single center's experience

Abstract

BackgroundPersistent pulmonary hypertension of the newborn (PPHN) is a serious condition characterized by elevation of pulmonary vascular resistance. Pulmonary vasodilators are currently used as a rescue therapy or combined with inhaled nitric oxide in patients with PPHN. ObjectiveThis study aimed to determine the effect of bosentan and sildenafil on the oxygenation and short-term adverse events of patients with PPHN. MethodsA retrospective study was conducted in neonates diagnosed with PPHN and received bosentan or sildenafil therapy between 2010 and 2017 at the neonatal intensive care unit of tertiary referral hospital in Thailand. ResultsA total of 31 neonates with PPHN were included in this study. The median (IQR) gestation age and mean ± SD birth weight were 38 (36–40) weeks and 2961 ± 888 g, respectively. Of the 31 neonates, 16 received bosentan and 15 received sildenafil treatment. The initial mean oxygen index (OI) in the bosentan group was 18.7 ± 16.7, which decreased significantly at 24 h after treatment (OI = 8.5 ± 6.3, p < 0.001). In the sildenafil group, the initial mean OI was 47.1 ± 33.2, which decreased dramatically at 24 h after treatment (OI = 23.4 ± 19.5, p < 0.001). Oxygen saturation significantly improved at 96 h of bosentan and 36 h of sildenafil treatment, respectively. Blood pressure before and after treatment were not significantly different changed in both groups. ConclusionsBosentan and sildenafil are effective pulmonary vasodilators that are safe in PPHN treatment. Both drugs can be used as a rescue therapy in patients with PPHN, especially in centers lacking inhalable nitric oxide.