Severe pulmonary arterial hypertension in a very premature baby with bronchopulmonary dysplasia: normalization with long-term sildenafil

Caputo, Salvatore; Furcolo, Giuseppe; Rabuano, Raffaello; Basilicata, Angelo Maria; Pilla, Luigi Maria; Simone, Alfredo De; Pasquariello, Brigida; Ciampi, Quirino; Vetrano, Gennaro; Villari, Bruno

doi:10.2459/jcm.0b013e328332e745

Cited by 25 publications

(16 citation statements)

References 16 publications

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“…There are many differences between the mechanism of pulmonary injury and parenchymal damage that occur in infants with BPD-associated PH, when compared with adults with chronic obstructive pulmonary disease-associated PH, which make it difficult to 20 in an open-label single drug study, evaluated sildenafil citrate therapy for neonatal PH, which included one infant with BPD-associated PH. Caputo et al, 21 in a case report, describe treating one infant with sildenafil citrate for BPD-associated PH. The present report adds to this published experience and represents the largest group of infants treated with sildenafil citrate for BPD-associated PH to date.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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“…[13][14][15][16][17][18][19][20] Early clinical experience indicates that sildenafil treatment may be efficacious for infants with BPD-PH, with evidence suggesting that sildenafil normalizes lung development and may improve outcomes. [21][22][23][24][25] However, practice patterns for sildenafil treatment in infants with BPD-PH have not been fully reported; these patterns include variables associated with exposure, timing of initiation, length of treatment, and interhospital variation in use. Current sildenafil exposure among infants with BPD-PH remains influenced largely by the personal preferences of individual physicians and single-center experiences of safety and efficacy.…”

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confidence: 99%

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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“…Доказана патогенетическая близость ретинопатии и БЛД у недоношенных детей: связующи-ми оказались нарушения генной регуляции ангиогенеза [28,29]. Показано ухудшающее прогноз влияние гемоди-намически значимого открытого артериального протока [30], легочной гипертензии [31], некротизирующего энте-роколита. Доказано влияние на исход БЛД респираторно-синцитиальной вирусной (РСВ) инфекции [1,32].…”

Section: исходы бронхолегочной дисплазииunclassified

Bronchopulmonary Dysplasia: a Modern View on Course and Outcomes

Казакова

2016

Pediatr. farmakol.

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ВВЕДЕНИЕБронхолегочная дисплазия (БЛД) -полиэтиологич-ное хроническое заболевание морфологически незрелых легких, развивающееся у новорожденных, главным обра-зом глубоко недоношенных детей, получающих кисло-родотерапию и находящихся на искусственной вентиля-ции легких (ИВЛ). Клиническая картина характеризуется преимущественным поражением бронхиол и паренхимы легких, развитием эмфиземы, фиброза и/или нарушени-ем репликации альвеол, кислородозависимостью в воз-расте 28 сут жизни и старше, бронхообструктивным синдромом и другими симптомами дыхательной недоста-точности. Для болезни специфичны рентгенологические изменения и регресс клинических проявлений по мере роста ребенка [1][2][3]. Определение БЛД, как и представ-ления о факторах, способствующих развитию заболе-вания, его частоте, классификации, сведения о патоге-незе и превентивных мерах подробно изложены в ряде отечественных и зарубежных монографий и закреплены рекомендациями Российского респираторного общества и Союза педиатров России [1][2][3]. Это позволило достичь единообразия в используемой терминологии и сделать эти представления практически общепринятыми.В настоящем обзоре проанализирована современ-ная литература, касающаяся факторов риска формиро-вания БЛД, течения и исхода заболевания. ТЕЧЕНИЕ БРОНХОЛЕГОЧНОЙ ДИСПЛАЗИИРазвитие БЛД описывается с разных позиций. В част-ности, анализируются особенности клинических прояв-лений болезни, обусловливающих тяжесть повреждения бронхолегочной системы, в том числе в зависимости от возраста, массы тела при рождении, проводимой тера-пии. Кроме того, учитываются результаты функциональ-ных тестов, рентгенологических изменений, эпизодов обострений и их частота.Типичными для детей с БЛД считают синдромы утечки воздуха (пневмоторакс, пневмомедиастинум, интерстициальная эмфизема), приступы апноэ с бра-дикардией, приобретенные инфекционные процессы в легких (пневмонии, бронхиты как обострение заболе-вания) в сочетании с дефицитными состояниями недо-

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Severe pulmonary arterial hypertension in a very premature baby with bronchopulmonary dysplasia: normalization with long-term sildenafil

Cited by 25 publications

References 16 publications

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

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

Sildenafil Treatment of Infants With Bronchopulmonary Dysplasia–Associated Pulmonary Hypertension

Bronchopulmonary Dysplasia: a Modern View on Course and Outcomes

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