Department of Neonatology and Pediatric Critical Care Medicine, University Children's Hospital Bonn, Bonn, Germany.
Department of Obstetrics and Prenatal Medicine, University of Bonn Medical Center, Bonn, Germany.
Pediatr Pulmonol. 2018 Apr;53(4):452-460. doi: 10.1002/ppul.23935. Epub 2018 Jan 5.
Pulmonary hypertension (PH) is an important contributor of morbidity and mortality in infants with congenital diaphragmatic hernia (CDH). Treatment options are limited, but sildenafil might improve oxygenation and PH in neonates with CDH.
Aim of this study is to assess effects of intravenous sildenafil on oxygenation and PH in neonates with CDH.
A retrospective chart review was performed in all neonates with CDH born in our institution between September 2012 and December 2014. Indication for sildenafil was an OI > 15, PH > 2/3 systemic pressure, or a difference in pre- and postductal oxygen saturation (≥8%). A sildenafil bolus was administered followed by a maintenance infusion of 1.6 mg/kg/d. Primary outcome was improved oxygenation after starting sildenafil. Patients were compared according to improvement in oxygenation (responder vs non-responder).
A total of 26 of 44 neonates were treated with intravenous sildenafil and in all sildenafil were initiated within the first 24 h of life (median age 3.1 h). Improved oxygenation was observed in 11 infants (42.3%). Among the 15 non-responders (57.6%) ECMO was started in 13 and two infants died without ECMO. Vasopressor support increased significantly during the first hours after commencing sildenafil in responders and non-responders. Echocardiographic indices demonstrated an effect on pulmonary arterial pressure within the first 24 h after starting sildenafil.
Treatment of neonates with intravenous sildenafil during the first day of life was associated with acute improvement in oxygenation in more than 40% of patients. However, a significant increase in vasopressor support was observed.
肺动脉高压（PH）是先天性膈疝（CDH）患儿发病率和死亡率的重要原因。治疗选择有限，但西地那非可能改善 CDH 新生儿的氧合和 PH。
本研究旨在评估静脉内西地那非对 CDH 新生儿氧合和 PH 的影响。
对 2012 年 9 月至 2014 年 12 月在我院出生的所有 CDH 新生儿进行回顾性图表审查。西地那非的适应证为氧合指数（OI）>15、PH>2/3 体循环压或导管前和导管后氧饱和度差异（≥8%）。给予西地那非推注，然后以 1.6mg/kg/d 的维持剂量输注。主要结局为开始西地那非后氧合改善。根据氧合改善情况（应答者与无应答者）比较患者。
共有 44 例新生儿接受了静脉内西地那非治疗，所有患者均在出生后 24 小时内开始使用（中位年龄 3.1 小时）。11 例（42.3%）患儿氧合改善。在 15 例无应答者（57.6%）中，13 例开始使用 ECMO，2 例患儿未使用 ECMO 死亡。在开始西地那非后的最初几小时内，应答者和无应答者的血管加压素支持显著增加。在开始使用西地那非后的 24 小时内，超声心动图指标显示对肺动脉压有影响。
在出生后第一天对新生儿进行静脉内西地那非治疗与超过 40%的患者的氧合急性改善相关，但观察到血管加压素支持显著增加。
