Sichuan University/Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Department of Neonatology, West China Second Hospital, Ministry of Education, Chengdu, China.
West China School of Medicine, Sichuan University, Chengdu City, China.
Pediatr Pulmonol. 2024 Dec;59(12):3467-3482. doi: 10.1002/ppul.27234. Epub 2024 Aug 28.
To compare the efficacy and safety of different vasodilators in the treatment of persistent pulmonary hypertension of the newborn (PPHN) by a Bayesian network meta-analysis.
We searched databases (Cochrane, PubMed, Embase, and Web of Science) from January, 1990 up to December, 2023. Randomized controlled trials on the use of vasodilators in the treatment of PPHN. We extracted details of population, intervention, and outcome indicators. R and STATA software were used for data analysis. Sixteen articles were included, encompassing 776 neonates with PPHN. Among them, 12 articles were included in the quantitative analysis. The vasodilators included Sildenafil, Bosentan, Milrinone, Magnesium, Adenosine, and Tadalafil.
The Bayesian network meta-analysis results suggested that compared to placebo, Milrinone [OR = 0.125, 95% CI (0.0261, 0.562)], Sildenafil [OR = 0.144, 95% CI (0.0428, 0.420)], and Sildenafil_Milrinone [OR = 0.0575, 95% CI (0.00736, 0.364)] reduced the mortality, but the difference among the three was not significant. There was also no significant difference in the incidence of hypotension, the duration of mechanical ventilation, and the use of extracorporeal membrane oxygenation among the vasodilators. Compared to Bosentan, Adenosine was more effective in reducing the oxygenation index [MD = -12.78, 95% CI (-25.56, -0.03)], and Magnesium was less effective in reducing the oxygenation index than Sildenafil [MD = 5.19, 95% CI (1.23, 9.2)].
Milrinone, Sildenafil, and Sildenafil_Milrinone reduced the mortality of neonates with PPHN. More clinical trials are needed to verify the efficacy and safety of vasodilators in the treatment of PPHN.
通过贝叶斯网状meta 分析比较不同血管扩张剂治疗新生儿持续性肺动脉高压（PPHN）的疗效和安全性。
我们检索了 1990 年 1 月至 2023 年 12 月的 Cochrane、PubMed、Embase 和 Web of Science 数据库。纳入使用血管扩张剂治疗 PPHN 的随机对照试验。我们提取了人群、干预和结局指标的详细信息。使用 R 和 STATA 软件进行数据分析。共纳入 16 篇文章，包含 776 例 PPHN 新生儿。其中 12 篇文章纳入定量分析。血管扩张剂包括西地那非、波生坦、米力农、镁、腺苷和他达拉非。
贝叶斯网状 meta 分析结果表明，与安慰剂相比，米力农[OR=0.125，95%CI（0.0261，0.562）]、西地那非[OR=0.144，95%CI（0.0428，0.420）]和西地那非-米力农[OR=0.0575，95%CI（0.00736，0.364）]降低了死亡率，但三者之间的差异无统计学意义。血管扩张剂之间的低血压发生率、机械通气时间和体外膜肺氧合的使用也无差异。与波生坦相比，腺苷更有效地降低氧合指数[MD=-12.78，95%CI（-25.56，-0.03）]，而镁比西地那非更有效地降低氧合指数[MD=5.19，95%CI（1.23，9.2）]。
米力农、西地那非和西地那非-米力农降低了 PPHN 新生儿的死亡率。需要更多的临床试验来验证血管扩张剂治疗 PPHN 的疗效和安全性。
