Department of Pediatric Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan.
Department of Neurosurgery and Neurology, Jinnah Medical and Dental College, Karachi, Pakistan.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):6787-6793. doi: 10.1080/14767058.2021.1923003. Epub 2021 May 12.
The prevalence of persistent pulmonary hypertension of newborn (PPHN) has been estimated 1.9/1000 live births. Although the efficacy of inhaled nitric oxide and extracorporeal membrane oxygenation in PPHN is well established but it is difficult to administer and monitor in resource limited countries. Owing to this, other treatment options need to be evaluated.
This is a prospective observational study conducted in the Pediatric Cardiology Department, NICVD, Karachi, from February 2020 to October 2020 after the approval from the Institutional Ethical Review Committee. All the neonates referred to our Unit were screened by echocardiography (echo) and those who fulfilled the inclusion criteria were included. Echo were done before starting sildenafil and after 72 h to assess the pressure gradient across tricuspid valve and right to left or bidirectional shunt across patent ductus arteriosus , patent foramen ovale , or both. Sildenafil was started with a dose of 1 mg/kg/dose thrice a day and increased to 2 mg/kg/dose after 48 h if partial pressure of oxygen (PO] did not increase. In neonates who did not respond to increased dose of Sildenafil were added on oral Bosentan 1 mg/kg/dose twice a day.
Total 82 newborns were enrolled. Fifty-two patients improved after 48 h so were continued on same treatment. Sildenafil dose was increased in 30 (37.9%) patients whose PO did not increase to at least 10% from baseline after 48 h of starting treatment. Three patients expired within 48-72 h. Out of 27 remaining patients, only four responded whereas 23 patients did not show any improvement. In these patients, Bosentan was supplemented along with sildenafil.
The results of our study show effectiveness of oral Sildenafil in treating PPHN. The overall improvement observed in the patients was overwhelming. Combination of Sildenafil with Bosentan is beneficial in patients who did not respond on Sildenafil alone.
据估计，新生儿持续性肺动脉高压（PPHN）的患病率为每 1000 例活产儿中有 1.9 例。虽然吸入一氧化氮和体外膜氧合在 PPHN 中的疗效已得到证实，但在资源有限的国家，其应用和监测较为困难。因此，需要评估其他治疗选择。
这是一项前瞻性观察性研究，于 2020 年 2 月至 10 月在卡拉奇国家心脏研究所儿科心脏病科进行，该研究获得了机构伦理审查委员会的批准。我们科室所有转来的新生儿均通过超声心动图（echo）进行筛查，符合纳入标准的患儿被纳入研究。在开始使用西地那非之前和使用西地那非 72 小时后，通过 echo 评估三尖瓣跨瓣压力梯度以及动脉导管未闭、卵圆孔未闭或两者之间的右向左或双向分流情况。西地那非的起始剂量为 1mg/kg/剂量，每天 3 次，如果血氧分压（PO]没有增加，则增加至 2mg/kg/剂量，每天 3 次。如果增加剂量的西地那非治疗后患儿的血氧分压没有增加至少 10%，则在 48 小时后，加用口服波生坦，剂量为 1mg/kg/剂量，每天 2 次。
共纳入 82 名新生儿。48 小时后，52 名患儿病情改善，继续接受相同治疗。在血氧分压没有增加至少 10%的 30 名患儿（37.9%）中，增加了西地那非的剂量，这些患儿在开始治疗后 48 小时后血氧分压没有增加。3 名患儿在 48-72 小时内死亡。在其余 27 名患儿中，只有 4 名患儿有效，而 23 名患儿没有任何改善。在这些患儿中，西地那非联合波生坦治疗。
我们的研究结果表明，口服西地那非治疗 PPHN 是有效的。患者的整体改善效果显著。西地那非联合波生坦治疗对单独应用西地那非治疗无效的患者有益。
