sildenafil-citrate and Asphyxia-Neonatorum

Persistent pulmonary hypertension of the newborn (PPHN) is a syndrome of failed circulatory adaptation at birth, seen in about 2/1000 live born infants. While it is mostly seen in term and near-term infants, it can be recognized in some premature infants with respiratory distress or bronchopulmonary dysplasia. Most commonly, PPHN is secondary to delayed or impaired relaxation of the pulmonary vasculature associated with diverse neonatal pulmonary pathologies, such as meconium aspiration syndrome, congenital diaphragmatic hernia, and respiratory distress syndrome. Gentle ventilation strategies, lung recruitment, inhaled nitric oxide, and surfactant therapy have improved outcome and reduced the need for extracorporeal membrane oxygenation (ECMO) in PPHN. Newer modalities of treatment discussed in this article include systemic and inhaled vasodilators like sildenafil, prostaglandin E1, prostacyclin, and endothelin antagonists. With prompt recognition/treatment and early referral to ECMO centers, the mortality rate for PPHN has significantly decreased. However, the risk of potential neurodevelopmental impairment warrants close follow-up after discharge for infants with PPHN.

Topics: Administration, Inhalation; Alprostadil; Asphyxia Neonatorum; Endothelium-Dependent Relaxing Factors; Epoprostenol; Extracorporeal Membrane Oxygenation; Hernia, Diaphragmatic; Hernias, Diaphragmatic, Congenital; Humans; Infant, Newborn; Meconium Aspiration Syndrome; Nitric Oxide; Oxygen Inhalation Therapy; Persistent Fetal Circulation Syndrome; Piperazines; Pulmonary Surfactants; Purines; Respiration, Artificial; Respiratory Distress Syndrome, Newborn; Sildenafil Citrate; Sulfones; Vascular Resistance; Vasodilator Agents

Persistent pulmonary hypertension of the newborn (PPHN) was described in 1969 by Gersomy and co-workers as persistent foetal circulation. Supra - systemic pulmonary artery pressures result in right to left shunting of blood through the ductus arteriosus and/or foramen ovale. This results from failure of the normal adaptation to extra uterine life of the foetal heart/lung system. The incidence is estimated at about 0.1-0.2% of live born infants, majority being term or post term. There is no race or gender related predisposition. Management was always difficult before the advent of nitric oxide (and now sildenafil). We report two newborn infants born at The Mater Hospital with perinatal asphyxia resulting inpersistent pulmonary hypertension that were successfully managed with sildenafil.

Topics: Asphyxia Neonatorum; Chronic Disease; Female; Humans; Hypertension, Pulmonary; Hypoxia; Infant, Newborn; Pharmacy Service, Hospital; Piperazines; Purines; Sildenafil Citrate; Sulfones; Treatment Outcome; Vasodilator Agents