Sildenafil for PPHN

[takshafat]

Hi everybody,is there any role for sildenafil in pphn

[Zakariya Al-Salam]

Well, I think it is worth to try it in places where iNO is not available or if your patient is difficult to wean off iNO. So far there is only one RCT in human neonate with PPHN that suggests improvement in oxygenation indices:

Baquero H et al. Oral sildenafil in infants with persistent pulmonary hypertension of the newborn: a pilot randomized blinded study. Pediatrics. 2006 Apr;117(4):1077-83.

Note this study has a very limited number of subjects.

There are also other case reports and case series in human neonates in addition to animal models of PPHN. In animal it was given IV, by nebulization or through endotracheal tube with surfactant. The results are encouraging.

Shekerdemian L et al. Intravenous sildenafil lowers pulmonary vascular resistance in a model of neonatal pulmonary hypertension. Am J Respir Crit Care Med. 2002;165 :1098 –1102

Ichinose F et al. Nebulized sildenafil is a selective pulmonary vasodilator in lambs with acute pulmonary hypertension. Crit Care Med. 2001;29 :1000 –1005a

Haase E, et al Dose response of intravenous sildenafil on systemic and regional hemodynamics in hypoxic neonatal piglets. Shock. 2006 Jul;26(1):99-106.

Obaid L et al. Intratracheal administration of sildenafil and surfactant alleviates the pulmonary hypertension in newborn piglets. Resuscitation. 2006 May;69(2):287-94. Epub 2006 Feb 23.

Hope this is useful

Zakariya Al-Salam

[takshafat]

thanks zakariya,yes we dont have iNO available,would like to try sildenafil for pphn,although we have started using it for primary pulmonary hypertension in children,whiich seems to be quite common in our part,the typical age of presentation being one to three months,with the most common admission diagnosis of bronchiolitis

[Guest Dr. Petrov]

In our unit we started to use oral sildenafil 0.5 mg/kg/6 h for PPHN about a year ago. First impression of sildenafil is that it is less effective than magnesium sulfate 50-200 mg/kg/h i.v, traditionally used for these cases. Of course, adittional analisis is required.

[DR Ramlawi]

sildenafil

is one of the major therapeutic lines for PPHN, usually it is a bridge to take the pt away from inhaled NO, and it can be used by itself as the primary therapy in moderate cases of PPHN

in fact we have pts with severe PPHN which we treated with Sildenafil with good response, and with minimal side effectseven some newborn infants treated with it till age of 2 year. There is good article about it just published

the journal of pediatrics Nov 2009