Therapeutic combination of sildenafil and iloprost in a preterm neonate with pulmonary hypertension

Gürakan, Berkan; Kayıran, Petek; Öztürk, Nilüfer Yalındağ; Kayıran, Sinan Mahir; Dindar, Aygün

doi:10.1002/ppul.21415

Cited by 26 publications

(15 citation statements)

References 15 publications

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“…In our institution, nitric oxide is used to treat PH in babies still dependent on MV, and oral sildenafil is the first choice for oral treatment (sometimes added for nitric oxide weaning). In our experience, inhaled iloprost can acutely and significantly improve oxygenation, but its chronic use in MV dependent patients is often precluded by the appearance of hemoptoic secretions; on the contrary, and as reported by other authors, it can be very useful in patients receiving only supplemental oxygen or noninvasive MV. Oral Bosentan and subcutaneous treprostinil are added in the most severe cases.…”

Section: Discussionsupporting

confidence: 66%

Pulmonary hypertension in bronchopulmonary dysplasia: Clinical findings, cardiovascular anomalies and outcomes

Cerro

Sabaté-Rotés

Cartón

et al. 2013

Pediatric Pulmonology

160

119

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Section: Discussionsupporting

confidence: 66%

Pulmonary hypertension in bronchopulmonary dysplasia: Clinical findings, cardiovascular anomalies and outcomes

Cerro

Sabaté-Rotés

Cartón

et al. 2013

Pediatric Pulmonology

160

119

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show abstract

“…Data are limited regarding prostanoid–sildenafil combinations; however, one case study describes a 4-month-old preterm infant 38. Intravenous iloprost (2 ng/kg/min), oral sildenafil (0.5 mg/kg every 6 h, maximum 0.8 mg/kg/dose) and digoxin (10 µg/kg/day) were used.…”

Section: Sildenafil Evidencementioning

confidence: 99%

The utility of sildenafil in pulmonary hypertension: a focus on bronchopulmonary dysplasia

Wardle

Luyt

et al. 2013

Archives of Disease in Childhood

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The treatment of pulmonary hypertension (PH) secondary to bronchopulmonary dysplasia (BPD) in infants has evolved in recent years, improving both quality of life and survival for patients. One of the potential agents for this condition is sildenafil, a phosphodiesterase-V inhibitor with proven efficacy within the idiopathic PH population. However, only limited evidence exists for its use as either monotherapy or part of a combination approach towards the management of PH in BPD. This review summarises the evidence base for sildenafil alone and in combination with other recognised therapeutic agents for ameliorating paediatric PH in the presence of BPD. It also examines the suitability for current practice with the aim of clarifying regimens that produce improved patient outcomes. We conclude that sildenafil is both safe and effective in this utility. Doses should be started at 0.5 mg/kg every 8 h before titrating up towards 2 mg/kg every 6 h to effect reductions in pulmonary vascular resistance and arterial pressure. Evidence suggests that if continued until PH resolution, this improves survival from 61% to 81% at 12 months. Furthermore, there are also data suggesting that in treatment refractory PH cases, the addition of endothelin antagonists and prostacyclin analogues to sildenafil therapy can also be considered.

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“…Bronchopulmonary dysplasia can cause pulmonary hypertension, but current evidence suggests 8 mg/kg/day sildenafil safely controls this. Contemporary information exists in the form of monotherapy case studies,17 as well as those involving the combination of sildenafil with nitric oxide,18 prostanoids or ERAs 19 20. However, due to a lack of high order evidence and formal approval, as well as the propensity of such data for publication bias, the prescription of sildenafil should be restricted to specialists.…”

Section: Sildenafilmentioning

confidence: 99%

Paediatric pulmonary hypertension and sildenafil: current practice and controversies

Wardle

Tulloh

2013

Arch Dis Child Educ Pract Ed

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In recent times, paediatric pulmonary arterial hypertension management has been transformed to focus on disease modifying strategies that improve both quality of life and survival, rather than just symptom palliation. Sildenafil, a phosphodiesterase-V inhibitor, has been at the centre of this. Despite controversial beginnings, its success in treating pulmonary arterial hypertension has led to its consideration for related pathologies such as persistent pulmonary hypertension of the newborn and bronchopulmonary dysplasia, as well as the development of a range of alternative formulations. However, this has caused its own controversy and confusion regarding the use of sildenafil in younger patients. In addition, recent data regarding long-term mortality and the repeal of US drugs approval have complicated the issue. Despite such setbacks, sildenafil continues to be a major component of the contemporary care of paediatric pulmonary hypertension in a variety of contexts, and this does not seem likely to change in the foreseeable future.

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Therapeutic combination of sildenafil and iloprost in a preterm neonate with pulmonary hypertension

Cited by 26 publications

References 15 publications

Pulmonary hypertension in bronchopulmonary dysplasia: Clinical findings, cardiovascular anomalies and outcomes

Pulmonary hypertension in bronchopulmonary dysplasia: Clinical findings, cardiovascular anomalies and outcomes

The utility of sildenafil in pulmonary hypertension: a focus on bronchopulmonary dysplasia

Paediatric pulmonary hypertension and sildenafil: current practice and controversies

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