Intratracheal Sildenafil in the Newborn With Pulmonary Hypertension

Martell, Miguel; Blasina, Fernanda; Silvera, Fernando; Tellechea, Salvador; Godoy, Carolina; Vaamonde, Lucía; Benenatti, Luana; Olivera, Walter

doi:10.1542/peds.2006-2567

Cited by 15 publications

(12 citation statements)

References 8 publications

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“…Pharmacokinetics and bioavailability of orally administered sildenafil has not been studied so far in neonates. A recent report by Martell et al 43 have shown a significant drop in pulmonary pressures within 2 min following intratracheal administration of 0.75 or 1.5 mg kg À1 dose of sildenafil in piglets with meconium aspiration. Inotropic support was needed to maintain systemic blood pressure.…”

Section: Phosphodiesterase Inhibitorsmentioning

confidence: 93%

Pharmacotherapy for meconium aspiration

Asad

Bhat

2008

J Perinatol

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In this article we have attempted to review the current pharmacological treatment options for infants with meconium aspiration syndrome with or without persistent pulmonary hypertension. These treatments include ventilatory support, surfactant treatment and inhaled nitric oxide (INO), in addition to older and newer pharmacological treatments. These include sedatives, muscle relaxants, alkali infusion, antibiotics and the newer vasodilators. Many aspects of treatment, including ventilatory care, surfactant treatment and the use of INO, are reviewed in great detail in this issue. On the other hand, many newer pharmacological modalities of treatment described here have not been evaluated with randomized control trials. We have given an overview of these emerging therapies.

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Section: Phosphodiesterase Inhibitorsmentioning

confidence: 93%

Pharmacotherapy for meconium aspiration

Asad

Bhat

2008

J Perinatol

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“…32 Both doses were shown to decrease mean pulmonary arterial pressures within 2 minutes of administration, with an effect observed for 120 minutes. Human studies are necessary to confirm this effect.…”

Section: Phosphodiesterase V Inhibitorsmentioning

confidence: 97%

Pediatric Pulmonary Hypertension: A Pharmacotherapeutic Review

Pesaturo

Johnson

Ramsey

2009

Journal of Pharmacy Practice

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Pulmonary hypertension in children is a disorder associated with increased pulmonary vascular resistance and arterial pressure, decreased cardiac output, and right-sided cardiac dysfunction that is caused by numerous etiologies. Although treatment will vary with underlying cause, pharmacological treatment has historically included inhaled nitric oxide and prostacyclin analogues. Over the past several years new agents have been added to the treatment armamentarium, including phosphodiesterase V inhibitors (eg sildenafil) and endothelin antagonists (eg bosentan). Further, more agents are currently under investigation for pulmonary hypertension in children including immunosuppressives and other endothelin antagonist entities. Limitations to treatment include the availability of appropriate, robust pediatric pharmacological data and constraints with dosage forms. P ulmonary hypertension (PHN) in children is a disorder associated with increased pulmonary vascular resistance and arterial pressures, decreased cardiac output, and right-hand side cardiac dysfunction. In the 1970s, PHN carried a prognosis of less than 1 year of life following diagnosis. 1 However, with advancements in pharmacological treatment over the past three decades, the prognosis improved. Current estimates for the 5-year survival rate in pharmacologically-treated children are now as high as 90%. 1 Though once considered rare, PHN is now diagnosed at an increased frequency; however, the actual incidence of PHN in children still remains unknown. 2 Several classes of drug therapy exist for the treatment of various etiologies of PHN in neonates, infants and children. These agents include inhaled nitric oxide, prostacyclins, phosphodiesterase V inhibitors, endothelin antagonists, calcium channel blockers (CCBs), and several other novel therapeutic approaches. This review serves to introduce the reader to the existing data for pharmacological treatment and provide insight into therapeutic approaches to optimizing therapy of PHN and appropriate goals of therapy (Table 1).Pulmonary hypertension is caused by numerous etiologies and can be due to acute or chronic changes, and may be transient or permanent. Pulmonary hypertension is divided into 2 main categories, primary and secondary; primary PHN is generally idiopathic and sporadic, with a link to familial inheritance in up to 10% of cases. 2 Secondary PHN is associated with underlying disorders including, but not limited to, pulmonary arterial hypertension (associated with congenital heart disease and connective tissue diseases) or PHN associated with respiratory

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“…Sildenafil (0.75 or 1.5 mg/kg per dose administered intratracheally) induced a rapid decrease in mean pulmonary arterial pressure (PAP), which occurred as soon as 2 minutes and lasted for 120 minutes. [24]…”

Section: Sildenafil For Pphn: Case Reports and Clinical Trialsmentioning

confidence: 99%

“…The most used route of administration has been oral, and the duration of the effect goes from 20 minutes to 6 hours afterward. [2427]…”

Section: Sildenafil For Pphn: Case Reports and Clinical Trialsmentioning

confidence: 99%

Is sildenafil an effective therapy in the management of persistent pulmonary hypertension?

2012

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Persistent pulmonary hypertension of the newborn (PPHN) is a life-threatening neonatal pathology resulting from poor hemodynamic and respiratory transition to extra uterine life. Inhaled nitric oxide (iNO) is a current, commonly used treatment of PPHN. However, iNO is not available therapy in many developing countries and around 50% of infants with PPHN do not respond to iNO therapy. Sildenafil is a phosphodiesterase inhibitor type 5 (PDE5) that has been shown to selectively reduce pulmonary vascular resistance in both animal models and adult humans. Recent studies have found that in PPHN, administration of Sildenafil was associated with a significant increase in the oxygenation and a reduction in mortality with no clinically important side effects.

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Intratracheal Sildenafil in the Newborn With Pulmonary Hypertension

Cited by 15 publications

References 8 publications

Pharmacotherapy for meconium aspiration

Pharmacotherapy for meconium aspiration

Pediatric Pulmonary Hypertension: A Pharmacotherapeutic Review

Is sildenafil an effective therapy in the management of persistent pulmonary hypertension?

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