Intravenous sildenafil therapy in Persistant Pulmonary Hypertension of the Newborn in a Resource limited Hospital setting

Volume : VII, Issue : VI, June - 2018

Ram Sharma, K. Sharada Kothapalli, Dalip Kumar Bhagwani, Ruby Saklani

Objective: The aim of the study was to determine the effectiveness (oxygenation) and immediate outcome of intravenous (IV) sildenafil therapy in

persistant pulmonary hypertension of the newborn (PPHN).

Design: Retrospective medical records review

Setting: Neonatal intensive care unit (NICU) of a tertiary Hospital Delhi, India

Method: case records of Newborns who received IV Sildenafil between October 2015 and October 2016 at NICU of Hindu Rao Hospital, Delhi

were reviewed .Inclusion criteria for the study was Newborns with Echocardiography (ECHO) proven PPHN .Exclusion criteria were presence of

congenital heart disease and any evident major congenital anomaly. Informed consent was obtained from all the parents of neonates prior to starting

IV sildenafil with emphasis of non availability of iNO (inhaled Nitric Oxide) and ECMO (Exra corporeal memane oxygenation) in our setup.

Result: Neonates who presented with severe hypoxemia underwent screening with ECHO. Out of 22 newborn babies screened 15 were diagnosed

to be PPHN. Median gestation of the newborns was 39 weeks. All the babies had a response to the IV sildenafil therapy in the form of improvement

in oxygen saturation by the time loading dose was given @0.4 mg/kg/ over 3 hours. The mean duration of IV sildenafil given was 4 days and the

maximum duration given was 14 days. All newborns received ionotropes dopamine, dobutamine, epinephrine either alone or both or all three

respectively to provide blood pressure support. The survival rate in babies given IV sIldenafil was 73.33%.

Conclusion: IV Sildenafil is an effective therapy in improving oxygenation of babies diagnosed with PPHN especially in limited resource centres

where iNO /ECMO is unavailable.