The aim of this prospective, randomized and controlled study was to compare the clinical efficacy of intravenous magnesium sulfate (MgSO₄) and oral sildenafil therapies with persistent pulmonary hypertension of the newborn. A total of 34 infants in the MgSO₄ group and 31 infants in the sildenafil group completed the study. The time to reach the adequate clinical response [defined as oxygen index (OI) level of <15, a pulmonary artery pressure of < 20 mmHg) was significantly shorter in the sildenafil group (p = 0.002). Duration of mechanical ventilation was longer and the number of the patients requiring inotropic support was higher in the MgSO₄ group (p = 0.001 and p = 0.002, respectively). Although among two groups the difference in OI > 5 as speculated in our hypothesis could only be found at 36 h of the treatment, sildenafil was more effective than MgSO₄ in the treatment of persistent pulmonary hypertension of the newborns with regard to time to adequate clinical response, duration of mechanical ventilation and support requirement with inotropic agents.

A two-week-old term male infant, weighing 1,600 grams was transferred to the neonatology unit of Doküz Eylul University hospital with sharply demarcated cutaneous gangrene surrounding the perianal region. He did well at birth. In his history, on the 10th postnatal day, a red, painful, warm cutaneous lesion was observed which was thought to be secondary to repeated and inappropriate rectal temperature measurements. Besides an ill-appearing child, a nontender frank cutaneous gangrene developed within several days. Klebsiella pneumoniae was cultured from the involved area. Blood cultures were negative. A frozen section of soft tissue biopsy could not be performed because of the localization of the lesion. The patient was successfully treated by surgical debridement and high doses of parenteral antibiotics.

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