Intravenous Sildenafil in the Treatment of Neonates with Persistent Pulmonary Hypertension

Steinhorn, Robin H.; Kinsella, John P.; Pierce, Christine; Butrous, Ghazwan; Dilleen, Maria; Oakes, Michael; Wessel, David

doi:10.1016/j.jpeds.2009.06.012

Cited by 214 publications

(185 citation statements)

References 24 publications

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“…23,24,28,32,33 However, the absence of long-term safety and efficacy data 34 may have contributed to the fact that the majority (83%) of infants with BPD-PH in this study population did not receive sildenafil. Clinicians seem to reserve sildenafil for a "sicker" subgroup of infants with BPD-PH: those receiving sildenafil were born more prematurely, were more likely to be SGA, had more severe lung disease, and had longer hospitalizations.…”

Section: Discussionmentioning

confidence: 98%

“…Single-center experiences suggesting sildenafil therapy may improve outcomes 23,28 led us to investigate utilization patterns of this drug at US children' s hospitals. The main findings of our study are that patterns of utilization vary markedly between institutions and that infants with BPD-PH treated with sildenafil represent a high-risk subgroup of patients.…”

Section: Discussionmentioning

confidence: 99%

“…Steinhorn et al 28 described improvements in oxygenation status among infants 4 hours after sildenafil administration. Nyp et al 24 showed that, among 21 preterm infants with moderate or severe BPD, sildenafil exposure for a median of 167 days was associated with clinically significant reductions in estimated right ventricular peak systolic pressures.…”

Section: Discussionmentioning

confidence: 99%

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Sildenafil Treatment of Infants With Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

Backes

Reagan

Smith

et al. 2016

Hospital Pediatrics

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OBJECTIVE: This study had 2 goals: (1) to identify clinical and demographic characteristics associated with sildenafil exposure for infants with bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH); and (2) to characterize hospital-specific treatment frequency, age at first administration, and length of sildenafil treatment. METHODS: This retrospective cohort study used data from the Pediatric Health Information System to determine variables associated with sildenafil exposure and between-hospital variations in sildenafil utilization patterns. The study included infants with BPD-PH who were discharged between January 1, 2006, and December 31, 2013. RESULTS: Within 36 US pediatric hospitals, 3720 infants were diagnosed with BPD, of whom 598 (16%) also had a diagnosis of PH (BPD-PH). Among infants with BPD-PH, 104 infants (17%) received sildenafil. The odds for sildenafil treatment among infants born between 25 and 26 weeks’ gestational age (GA) and <24 weeks’ GA, respectively, were 2.26 (95% confidence interval [CI]: 1.20–4.24) and 3.21 (95% CI: 1.66–6.21) times those of infants born at 27 to 28 weeks’ GA. Severity of BPD correlated with sildenafil exposure, with adjusted odds ratios (ORs) for moderate BPD (OR: 3.03 [95% CI: 1.03–8.93]) and severe BPD (OR: 7.56 [95% CI: 2.50–22.88]), compared with mild BPD. Greater rates of sildenafil exposure were observed among small for GA neonates (OR: 2.32 [95% CI: 1.21–4.46]). The proportion of infants with BPD-PH exposed to sildenafil varied according to hospital (median: 15%; 25th–75th percentile: 0%–25%), as did the median duration of therapy (52 days; 25th–75th percentile: 28–109 days). CONCLUSIONS: The odds of sildenafil treatment were greatest among the most premature infants with severe forms of BPD. The frequency and duration of sildenafil exposure varied markedly according to institution. Patient-centered trials for infants with BPD-PH are needed to develop evidence-based practices.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Sildenafil Treatment of Infants With Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

Backes

Reagan

Smith

et al. 2016

Hospital Pediatrics

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“…6,7 Sildenafil citrate has also been used in infants with BPD-associated PH, focusing on long-term treatment and improvement in hemodynamics. 8,9 However, to our knowledge, no reports have described concomitant changes in pulmonary gas exchange at initiation of sildenafil citrate in infants treated for BPD-associated PH.…”

Section: Introductionmentioning

confidence: 99%

Sildenafil citrate, bronchopulmonary dysplasia and disordered pulmonary gas exchange: any benefits?

et al. 2011

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Objective: The objective of this study is to determine the effects that sildenafil citrate has on gas exchange in infants with bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH).Study Design: A retrospective review was performed from 2005 to 2009. Infants treated with sildenafil citrate for greater than 48 h were included. Standard patient data was collected, including echocardiogram, inspired oxygen and systemic blood pressure, before and during administration of sildenafil citrate.Result: Sildenafil citrate was used in 21 preterm infants with BPDassociated PH. A significant reduction in estimated right ventricular peak systolic pressure was seen after initiation of sildenafil citrate, with the majority of infants showing no improvement in gas exchange at 48 h of treatment. Four infants died during treatment. Conclusion:Sildenafil citrate reduced estimated pulmonary artery pressures, but this reduction was not reflected in improved gas exchange within the first 48 h.

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“…Однако, было отмечено, что силденафил увеличивает риск тяжелой ретинопатии недоношенных [65]. После исследований Управления по санитарному надзору за качеством пищевых продук-тов и медикаментов США (Food and Drug Administration, FDA), проведенных в 2012 г. и подтвердивших повыше-ние летальности при использовании силденафила для лечения легочной гипертензии в педиатрической прак- В настоящее время существуют резервные терапев ти-ческие возможности для пациентов с БЛД.…”

Section: (2с)unclassified

Managing Children with Bronchopulmonary Dysplasia

et al. 2016

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Bronchopulmonary dysplasia is one of the most significant early childhood chronic respiratory diseases. The article features modern approaches to preventing, diagnosing and treating broncho-pulmonary dysplasia, as well as ways of preventing complications and undesirable disease outcomes in patients older than 3 years. Members of professional associations — Union of Pediatricians of Russia and Russian Association of Perinatal Medicine Specialists — have summarized the experience of managing this category of patients at leading Russian pediatric centers according to the principles of evidence-based medicine and have provided scientific and practical data corresponding to the world level of knowledge with regard to the present problem.

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Intravenous Sildenafil in the Treatment of Neonates with Persistent Pulmonary Hypertension

Cited by 214 publications

References 24 publications

Sildenafil Treatment of Infants With Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

Sildenafil Treatment of Infants With Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

Sildenafil citrate, bronchopulmonary dysplasia and disordered pulmonary gas exchange: any benefits?

Managing Children with Bronchopulmonary Dysplasia

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