Efficacy of sildenafil in persistent pulmonary hypertension of the newborn.

Article Information

Title: Efficacy of sildenafil in persistent pulmonary hypertension of the newborn.

Authors: Muhammad Naveed, Fazal ur Rehman, Khurram Shahnawaz, Farhan Zahoor, Bushra Madni, Muhammad Imran

Journal: The Professional Medical Journal (TPMJ)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2022-07-01	2023-06-30
Y	2021-07-01	2022-06-30

Publisher: Independent Medical College, Faisalabad- Pakistan

Country: Pakistan

Year: 2022

Volume: 29

Issue: 4

Language: English

DOI: 10.29309/TPMJ/2022.29.04.6617

Keywords: NeonatesSildenafilOxygenationPersistent Pulmonary Hypertension of the Newborn

Abstract

Objective: To find out efficacy of sildenafil for the treatment of persistent pulmonary hypertension of the newborn (PPHN). Study Design: Observational study. Setting: Department of Neonatology, Sughra Shafi Medical Complex, Sahara Medical College, Narowal. Period: May 2020 to April 2021. Material &amp; Methods: A total of 22 neonates of both genders with diagnosis of PPHN were enrolled during the study period. Demographic characteristic along with information about perinatal and postnatal characteristics were recorded among all neonates at the time of admission. X-ray chest were asked. Oral sildenafil was administered as 2mg/kg per dose thrice a day to all study cases and continued till extubation. Outcome was recorded on the basis of difference in FiO2 need after initiating sildenafil, time required to get ventilator off or mortality. Results: Out of a total of 22 neonates, 13 (59.1%) were male. Majority of the neonates, 15 (68.2%) were term newborns. Mode of delivery was lower segment cesarean section in 17 (77.3%) cases. APGAR score at 5 minutes was between 7 to 10 in 13 (59.1%) newborns. There were 13 (59.1%) newborns who required immediate resuscitation following birth. Meconium aspiration syndrome was the commonest associated condition found among 8 (36.4%) neonates. As per echocardiographic findings, 13 (59.1%) neonates had severe PPHN, 5 (22.7%) moderate and 4 (18.2%) mild. Mean oxygenation index at the time of admission was noted to be 46+14. Inotropic support was administered to 19 (86.4%) cases. Mean length of neonatal intensive care unit was 15+5 days. Mortality was reported among 10 (45.4%) neonates. Conclusion: Oral sildenafil was found to be a promising option for the treatment of neonates having PPHN. Oral sildenafil was found to successfully improve oxygenation among neonates having PPHN.

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Research Objective

To determine the efficacy of sildenafil for the treatment of persistent pulmonary hypertension of the newborn (PPHN).

Methodology

Observational study conducted in the Department of Neonatology, Sughra Shafi Medical Complex, Sahara Medical College, Narowal, from May 2020 to April 2021. 22 neonates diagnosed with PPHN were enrolled. Oral sildenafil was administered at 2mg/kg per dose thrice daily until extubation. Outcomes were assessed based on the difference in FiO2 requirement, time to ventilator discontinuation, or mortality.

Methodology Flowchart

                        graph TD;
    A["Enroll 22 neonates with PPHN"] --> B["Record demographic, perinatal, postnatal characteristics"];
    B --> C["Administer oral sildenafil 2mg/kg thrice daily"];
    C --> D["Monitor FiO2 need, time to ventilator off, mortality"];
    D --> E["Analyze data using SPSS"];
    E --> F["Draw conclusions on sildenafil efficacy"];

Discussion

Sildenafil is considered a viable treatment option for PPHN, especially in resource-limited settings where inhaled nitric oxide and ECMO may not be readily available. The study observed a decline in fractional inspiratory oxygen demand with sildenafil treatment. The high mortality rate in PPHN is acknowledged, with associated conditions like meconium aspiration syndrome and respiratory distress syndrome being common. Limitations include the single-center design and small sample size, suggesting the need for multi-center studies with larger cohorts and comparative designs.

Key Findings

Oral sildenafil was found to be a promising option for treating PPHN in neonates, successfully improving oxygenation. Out of 22 neonates, 13 (59.1%) were male, and 15 (68.2%) were term newborns. Meconium aspiration syndrome was the most common associated condition (36.4%). Mortality was reported in 10 (45.4%) neonates. No major adverse events were reported.

Conclusion

Oral sildenafil is a promising treatment for neonates with PPHN, demonstrating success in improving oxygenation.

Fact Check

1. Study Period: The study was conducted from May 2020 to April 2021. (Confirmed in text)
2. Number of Neonates: A total of 22 neonates were enrolled in the study. (Confirmed in text)
3. Mortality Rate: Mortality was reported in 10 out of 22 neonates, which is 45.4%. (Confirmed in text)

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