Sildenafil, a phosphodiesterase-5 inhibitor, is a controversial treatment option for pulmonary arterial hypertension (PAH), a significant complication of bronchopulmonary dysplasia (BPD). The objective of this study was to evaluate the use of sildenafil in infants with PAH secondary to BPD. This was a retrospective review of medical records of all premature infants with PAH associated with BPD treated with sildenafil between January 2009 and May 2013 in a level 3 neonatal intensive care unit. The primary outcomes were clinical response (20 % decreases in respiratory support score or oxygen requirements) and echocardiographic response (20 % decrease in tricuspid regurgitation gradient or change of at least 1° of septal flattening). Twenty-three infants were included in the study. Significant echocardiographic and clinical responses were, respectively, observed in 71 and 35 % of cases. Most clinical responses were observed in the first 48 h of treatment, and the median time to an echocardiographic response was of 19 days. The median dose of sildenafil used was 4.4 mg/kg/day, with a median time to reach the maximum dose of 9 days. Transient hypotension was the primary reported side effect, and it was observed in 44 % of our study population. Sildenafil treatment in patients with PAH secondary to BPD was associated with an echocardiographic improvement in the majority of patients, whereas clinical improvement was observed in a minority of patients. Many infants presented with transient hypotension during the course of the treatment. Further prospective studies are required to better assess safety and efficacy of this treatment in this population.
Over the past 15 years, the number of studies investigating the potential teratogenic effects of antidepressants has drastically increased. Prescribing antidepressants during pregnancy is becoming a challenge for health care providers because of conflicting data on their teratogenic potential. A critical systematic review of studies describing the relationship between antidepressant use during pregnancy and its impact on congenital malformations, prematurity, low birth weight (LBW), and child development was undertaken to summarize the current evidence-based findings. Most antidepressants do not pose a major teratogenic risk, although the data supporting this conclusion vary from one type to another. While SSRIs and tricyclics have been examined in a considerable number of studies, only scarce data is available on new antidepressants. The use of paroxetine during organogenesis has been linked to an increase in the risk of cardiovascular malformations. The impact of prenatal exposure to antidepressants on prematurity and LBW remains controversial, and most studies evaluating these outcomes are limited by their small sample size and lack of adequate reference group. Finally, information on the long-term effects of gestational antidepressant use on child development is only starting to emerge, and existing information is too limited to determine the risk.
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