Sildenafil as “first line therapy” in pulmonary persistent hypertension of the newborn?

Abstract

Despite the recent advances, the clinical approach to persistent pulmonary hypertension of the newborn (PPHN) still represents an important challenge for neonatologists. The care of newborns with PPHN requires meticulous therapeutic and ventilation strategies including, besides the stabilization of the newborn, the use of nitric oxide and high-frequency ventilation. However, not all the neonates with PPHH are responsive to this clinical approach. Recent studies have proposed the use of sildenafil, a phosphodiesterase 5 inhibitor, in refractory forms of PPHN. The aim of this study is to review the cases and the clinical approach of PPHN in the Neonatal Intensive Care Unit of Meyer Children Hospital in the year 2009 and to discuss the possible role of sildenafil in the management of PPHN.

A randomized, double-blind, placebo-controlled, prospective study of bosentan for the treatment of persistent pulmonary hypertension of the newborn

“…Nitric oxide and ECMO are costly and may not be appropriate in resource-poor settings. 19 High plasma concentration of endothelin-1 in newborn infants with PPHN 7 has led to the use of endothelin-1 receptor antagonist such as bosentan for the treatment of PPHN.…”

The Impact of Combined Oral Sildenafil and Inhaled Nitric Oxide for Treating Persistent Pulmonary Hypertension of the Newborn: A Single Center Experience

“…In an analysis of a small population of neonates with PPHN it is reported that, apart from different underlying pathological conditions, time of beginning of iNO therapy is a strong predictor of outcome (19). As iNO is not available in all neonatal units yet, it is of great interest to identify alternative therapies that could be used immediately after the diagnosis of PPHN, or even in the presence of a strong clinical suspicion, before the arrival of the baby to the referral center.…”

PDE3 inhibition with enoximone as first‐line therapy for severe persistent pulmonary hypertension of the newborn during neonatal transport: a case report

“…Typically, a PDE5‐inhibitor is used for this indication (sildenafil). Sildenafil inhibits the cGMP‐degrading phosphodiesterase (PDE5), prolonging and/or enhancing the vasodilator effects of NO via soluble guanylate cyclase (sGC) . A recent Cochrane review and several later reviews support the use of sildenafil as first‐line therapy when iNO is not available, but a large‐scale randomized trial is still needed to assess efficacy and safety .…”