Juliana Amadu E, Abbad Filomena C B
Delfzicht Ziekenhuis, Jachtlaan 50, 9934 JD Delfzijl, The Netherlands.
Eur J Pediatr. 2005 Oct;164(10):626-9. doi: 10.1007/s00431-005-1724-x. Epub 2005 Jul 13.
We present the case of a full term neonate with severe persistent pulmonary hypertension of the newborn (PPHN) after birth asphyxia cared for at the St. Elizabeth Hospital in Curacao, Netherlands Antilles. Although the child was ventilated with high pressures and was given high doses of cardiovascular pressors, the arterial oxygen levels remained low with an alveolar-arterial O2 gradient of 651 mmHg. As a last resort, sildenafil (1.5 mg/kg) was given via a nasogastric tube. This resulted in an immediate and sustained elevation of arterial oxygenation and subsequent complete recovery. After administration of sildenafil there was a transient hypotension which was corrected by a single bolus of saline.
We discuss the current treatment modalities of persistent pulmonary hypertension of the newborn and the potential use of phosphodiesterase 5 inhibitors such as sildenafil in a situation where the standard of practice with inhaled nitric oxide and extracorporeal membrane oxygenation is not available.
我们介绍了一名足月新生儿的病例，该新生儿在出生窒息后患有严重的新生儿持续性肺动脉高压（PPHN），在荷属安的列斯群岛库拉索岛的圣伊丽莎白医院接受治疗。尽管该患儿接受了高压通气并给予了高剂量的心血管升压药，但动脉血氧水平仍然很低，肺泡-动脉氧梯度为651mmHg。作为最后的手段，通过鼻胃管给予西地那非（1.5mg/kg）。这导致动脉氧合立即且持续升高，随后完全康复。给予西地那非后出现短暂性低血压，通过单次推注生理盐水得以纠正。
我们讨论了新生儿持续性肺动脉高压的当前治疗方式，以及在无法采用吸入一氧化氮和体外膜肺氧合等标准治疗方法的情况下，磷酸二酯酶5抑制剂如西地那非的潜在用途。
