PULMONARY VASODILATOR THERAPY IN NEONATES WITH HYPOXIC RESPIRATORY FAILURE– A PROSPECTIVE COHORT STUDY.
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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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Deepa Kundargi
BLDE(DU), Shri B M Patil Medical College Hospital and Research Center, Vijayapura, Karnataka, India.
Vijayakumar Biradar
BLDE(DU), Shri B M Patil Medical College Hospital and Research Center, Vijayapura, Karnataka, India.
Siddu Charki
Associate Professor & Chief Neonatal Intensivist, BLDE (DU), Vijayapura, Karnataka, India
M M Patil
BLDE(DU), Shri B M Patil Medical College Hospital and Research Center, Vijayapura, Karnataka, India.