PULMONARY VASODILATOR THERAPY IN NEONATES WITH HYPOXIC RESPIRATORY FAILURE– A PROSPECTIVE COHORT STUDY.

Main Article Content

Deepa Kundargi
Vijayakumar Biradar
Siddu Charki
M M Patil

Keywords

Pulmonary hypertension, Neonate, Sildenafil, inhaled nitric oxide

Abstract

Abstract


Introduction: Acute hypoxemic respiratory failure (AHRF) in newborns continues to be a clinical challenge with elevated risk for significant morbidities and mortality, especially when accompanied with persistent pulmonary hypertension of the newborn (PPHN). The primary goal of PPHN therapy is selective pulmonary vasodilatation. Combination therapies are of considerable interest for treatment which fails to respond to iNO monotherapy.


Objective: To compare the efficacy of the combined intravenous sildenafil with inhaled nitric oxide therapy versus inhaled nitric oxide monotherapy for the treatment of Persistent Pulmonary Hypertension of neonates in terms of duration and weaning of iNO


Study Design: Neonates (gestational age >37 weeks) diagnosed with pulmonary hypertension were enrolled in the study. Neonates were categorized into two groups. Group I (n=9) received only inhaled nitric oxide whereas Group II (n=6) received combined therapy with inhaled nitric oxide and Intravenous sildenafil. Main outcome was to compare the efficacy and duration of inhaled nitric oxide therapy between the two groups.


Results: Demographic characteristics between the two groups showed similar results. Combination therapy helped in early weaning of inhaled nitric oxide (10.8±23 vs. 24±8.6 hours). The duration of inhaled nitric oxide therapy was significantly shortened in combined therapy group (56 [16-106] vs. 78 [21-186] hours), however, there was no statistical significance (p=0.2). The incidence of mortality and neonatal outcomes seemed to be same between the groups (p>0.05).


Conclusion: Combined therapy resulted in shorter duration of inhaled nitric oxide therapy. Neonates who received combined therapy had shorter NICU stay and were weaned off earlier compared to only iNO group

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References

Walsh-Sukys MC, Tyson JE, Wright LL, Bauer CR, Korones SB, Stevenson DK, et al. Persistent pulmonary hypertension of the newborn in the era before nitric oxide: practice variation and outcomes. Pediatrics 2000;105 (1):14-20.
2. Oishi P, Fineman JR. Pulmonary Hypertension. PediatrCritCareMed.2016;17(8):140-5.
3. Stayer SA, Liu Y. Pulmonary hypertension of the new-born. Best Pract Res Clin Anaesthesiol. 2010;24(3):375-86.
4. Finer NN, Barrington KJ. Nitric oxide therapy for the newborn infant. SeminPerinatol.2000;24(1):59-65.
5. Finer NN, Barrington KJ. Nitric oxide for respiratory failure in infants born at or near term. Cochrane Database SystRev2006;(4):CD000399.
6. Steinhorn RH. Diagnosis and treatment of pulmonary hy-pertension in infancy. Early Hum Dev 2013;89(11):865-74.
7. Steinhorn RH. Neonatal pulmonary hypertension. PediatrCritCareMed2010;11(2):79-84.
8. Baquero H, Soliz A, Neira F, Venegas ME, Sola A. Oral sildenafil in infants with persistent pulmonary hypertension of the newborn: a pilot randomized blinded study.Pediatrics2006;117(4):1077-83.
9. Dhariwal AK, Bavdekar SB. Sildenafil in pediatric pul-monary arterial hypertension. J Postgrad Med 2015;61(3):181-192.
10. Ahsman MJ, Witjes BC, Wildschut ED, Sluiter I, Vulto AG, Tibboel D, et al. Sildenafil exposure in neonates with pulmonary hypertension after administration via a nasogastric tube. ArchDisChildFetalNeonatalEd2010;95(2):109-14.
11. Roberts JD Jr, Fineman JR, Morin FC, Shaul PW, RimarS, Schreiber MD, et al. Inhaled nitric oxide and persistent pulmonary hypertension of the newborn. N Engl J Med.1997;336(9):605-10.
12. Clark RH, Kueser TJ, Walker MW, Southgate WM, Huckaby JL, Perez JA, et al. Low-dose nitric oxide therapy for persistent pulmonary hypertension of the new-born. Clinical Inhaled nitric oxide research Group.NEnglJMed2000;342(7):469-74.
13. Davidson D, Barefield ES ,Kattwinkel J, Dudell G, Damask M, Straube R, et al. Inhaled nitric oxide for the early treatment of persistent pulmonary hypertension of the term newborn : A randomized, double-masked, placebo-controlled, dose response, multicenter study. Pediatrics1998;101(3):325-34.
14. Neonatal Inhaled Nitric Oxide Study Group. Inhaled nitric oxide in full-term and nearly full-term infants with hypoxic respiratory failure. N Engl J Med 1997;336(9):597-604.
15. Lakshminrusimha S, Konduri GG, Steinhorn RH. Considerations in the management of hypoxemic respiratory failure and persistent pulmonary hypertension in term and late preterm neonates. JPerinatol2016;36(2):12-9.
16. Namachivayam P, Theilen U, Butt WW, Cooper SM, Penny DJ, Shekerdemian LS. Sildenafil prevents rebound pulmonary hypertension after withdrawal of nitric oxide in children. AmJRespirCritCareMed2006;174(9):1042-7.
17. Lee JE, Hillier SC, Knoderer CA. Use of sildenafil to facilitate weaning from inhaled nitric oxide in children with pulmonary hypertension following surgery for congenital heart disease. JIntensiveCareMed2008;23(5):329-34.
18. Shah PS, Ohlsson A. Sildenafil for pulmonary hyperten-sion in neonates. Cochrane Database Syst Rev 2011;(8):CD005494.
19. Nassi N, Daniotti M, Agostiniani S, Lombardi E, Favilli S, Donzelli GP. Sildenafil as “first line therapy” in pulmonary persistent hypertension of the newborn? J Matern Fetal Neonatal Med.2010;23(3):104-5