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

Department of Pediatrics, Children's Mercy Hospital and Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
Journal of perinatology: official journal of the California Perinatal Association (Impact Factor: 2.07). 09/2011; 32(1):64-9. DOI: 10.1038/jp.2011.131
Source: PubMed


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).
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.
Sildenafil citrate was used in 21 preterm infants with BPD-associated 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.
Sildenafil citrate reduced estimated pulmonary artery pressures, but this reduction was not reflected in improved gas exchange within the first 48  h.

Download full-text


Available from: Michael F Nyp, Jan 26, 2015
1 Follower
14 Reads
    • "Sildenafil and iNO are currently used for pulmonary vasodilatation , and both drugs have also been shown to improve alveolar growth and angiogenesis in animal mod - els ( Lin et al . , 2005 ; Horst et al . , 2007 ; Nyp et al . , 2012 ) . Currently , there is limited evidence except case reports for their role in pulmonary hypertension associated with BPD ( discussed in more detail in the article on Pulmonary Vas - cular Disease in BPD in the current issue of this journal ) ."
    [Show abstract] [Hide abstract]
    ABSTRACT: Since Northway's original description of BPD almost 45 years ago, the clinical presentation of BPD has evolved into a disease process, which mostly involves extremely premature infants. This new form of BPD is the result of multiple antenatal and postnatal factors that can cause injury to the developing lung leading to altered alveolar and vascular development. Over the years, there has been considerable increase in knowledge of factors that contribute to the development of BPD. This has led to different strategies for prevention as well as management of BPD. Some of these strategies have been successful and have withstood the test of clinical trials, such as vitamin A supplementation, post-natal steroids, caffeine, and volume targeted ventilation. The evidence for other interventions has been weak or negative. With better understanding of the complex and multifactorial pathogenesis of BPD, it is quite clear that any single therapy is very unlikely to eliminate this problem unless it reduces prematurity. Further development in prevention and treatment of BPD will likely need a multi-pronged strategy with novel therapeutic agents acting at various stages of the disease process. Birth Defects Research (Part A), 2014. © 2014 Wiley Periodicals, Inc.
    Birth Defects Research Part A Clinical and Molecular Teratology 03/2014; 100(3). DOI:10.1002/bdra.23229 · 2.09 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Sildenafil is occasionally used as rescue treatment for preterm infants with severe bronchopulmonary dysplasia and pulmonary arterial hypertension. In adults, sildenafil treatment has been associated with several ophthalmological adverse effects, including nonarteritic ischaemic optic neuropathy. We reviewed the effect of sildenafil on retinopathy of prematurity (ROP) in very preterm infants. Study design: Retrospective case-control study. Infants born <30 weeks gestation who had received sildenafil during their hospitalisation were included. A control group matched for gestation, birth weight, gender, and place of birth was identified from the departmental database. For every sildenafil case, three matched controls were studied. Baseline data, sildenafil therapy data, results of eye examinations and respiratory data were analysed. Result: 17 infants received sildenafil between 2004 and 2010. The median duration of sildenafil treatment was 52 days. Baseline characteristics were similar between groups. The odds ratio for an increase in ROP stage in the group treated with sildenafil was 1.35 (95% confidence interval 0.39-4.62, P-value 0.63). One infant in each group required laser treatment. Conclusion: Sildenafil treatment did not affect ROP progression or increase the need for laser treatment in this cohort.
    Journal of perinatology: official journal of the California Perinatal Association 07/2012; 33(3). DOI:10.1038/jp.2012.84 · 2.07 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The pulmonary circulation rapidly adapts at birth to establish lungs as the site of gas exchange. Abnormal transition at birth and/or parenchymal lung disease can result in neonatal hypoxemic respiratory failure. This article reviews the functional changes in pulmonary hemodynamics and structural changes in pulmonary vasculature secondary to (1) normal and abnormal transition at birth, and (2) diseases associated with neonatal hypoxemic respiratory failure. Various management strategies to correct respiratory failure are also discussed.
    Clinics in perinatology 09/2012; 39(3):655-83. DOI:10.1016/j.clp.2012.06.006 · 2.44 Impact Factor
Show more