Intravenous sildenafil for treatment of early pulmonary hypertension in preterm infants

Abstract

Data is lacking on the effect of continuous intravenous sildenafil treatment in preterm infants with early pulmonary hypertension (PH), especially in very low birth weight (VLBW) infants. Preterm infants (< 37 weeks of gestational age) with intravenous sildenafil treatment and diagnosis of PH between 01/12 and 12/21 were retrospectively screened for analysis. The primary clinical endpoint was defined as response to sildenafil according to the improvement of the oxygenation index (OI), the saturation oxygenation pressure index (SOPI) and PaO2/FiO2-ratio. Early-PH was defined as diagnosis < 28 day of life (DOL). 58 infants were finally included, with 47% classified as very low birth weight (VLBW) infants. The primary endpoint was reached in 57%. The likelihood to die during in-hospital treatment was more than three times higher (72 vs 21%, p < 0.001) in infants without response to sildenafil. The echocardiographic severity of PH and right-ventricular dysfunction (RVD) decreased significantly from baseline to 24 h (p = 0.045, and p = 0.008, respectively). Sildenafil treatment leads to significant improvement of the oxygenation impairment in 57% of the preterm infants, with similar response rates in VLBW infants. Intravenous sildenafil treatment is associated with a significant decrease of the PH-severity and RVD.

Vasoactive Management of Pulmonary Hypertension and Ventricular Dysfunction in Neonates Following Complicated Monochorionic Twin Pregnancies: A Single-Center Experience

“…Postnatal treatment with vasoactive drugs was due to the decision of the attending physician, according to in-hospital standards of clinical management. The echocardiographic assessment of PH or right-, left-, or bi-ventricular dysfunction (RVD, LVD, BVD) used in our department was described previously [25,27]. For the present study, the echocardiographic diagnostic reports of the attending physicians were retrospectively reviewed, and PH (moderate to severe), any cardiac dysfunction (CD), and subclassification into RVD/LVD/BVD were stated as present or not present according to the documented report/echocardiographic exam.…”

“…The choice of vasoactive drugs (classified as inotropes [dobutamine], inodilators [milrinone, levosimendan], vasopressors [norepinephrine, vasopressin], and beta blockers [propranolol, landiolol]) and drugs for PH treatment (iNO, intravenous/oral sildenafil, inhaled prostacyclin, bosentan) was made according to clinical and echocardiographic findings in the specific neonate, as described previously by our research group [25,27]. In terms of a need for beta blockade (for myocardial hypertrophy [MH] or selective HR control), neonates were treated with propranolol when oral administration was preferred and with landiolol intravenously when rapid intravenous beta blockade was necessary in the first DOL.…”

“…Potential candidates for drug treatments for PH management include inhaled nitric oxide (iNO), phosphodiesterase-3 (PDE-3) inhibitors (milrinone), phosphodiesterase-5 (PDE-5) inhibitors (intravenous or oral sildenafil), and endothelin-receptor 1 (ET-1) antagonists (bosentan), as well as new candidates such as the calcium sensitizer levosimendan, along with the possibility of selective heart rate (HR) control using intravenous agents (ivabradine, landiolol). The pharmacological and clinical effects of these drugs have been evaluated in preterm and term infants and described in previous studies [21][22][23][24][25][26][27]. Nevertheless, data regarding PH treatment in complicated MC twin pregnancies are not available.…”