Sildenafil for the Treatment of Pulmonary Arterial Hypertension in Infants with Bronchopulmonary Dysplasia

• Published in: Pediatric cardiology 2015-08, Vol.36 (6), p.1255-1260
• Main Authors: Trottier-Boucher, M. N., Lapointe, A., Malo, J., Fournier, A., Raboisson, M. J., Martin, B., Moussa, A.
• Format: Article
• Language: English
• Subjects: Bronchopulmonary dysplasia; Bronchopulmonary Dysplasia - complications; Bronchopulmonary Dysplasia - diagnostic imaging; Cardiac Surgery; Cardiology; Dose-Response Relationship, Drug; Drug therapy; Echocardiography; Female; Humans; Hypertension, Pulmonary - diagnostic imaging; Hypertension, Pulmonary - drug therapy; Hypertension, Pulmonary - etiology; Hypotension - chemically induced; Hypotension - epidemiology; Infant; Infant, Newborn; Infants (Premature); Intensive Care, Neonatal; Male; Medical records; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Neonatal intensive care; Neonatology; Original Article; Oxygen - metabolism; Phosphodiesterase 5 Inhibitors - therapeutic use; Pulmonary hypertension; Respiratory Rate - drug effects; Retrospective Studies; Sildenafil; Sildenafil Citrate - administration & dosage; Sildenafil Citrate - adverse effects; Sildenafil Citrate - therapeutic use; Treatment Outcome; Tricuspid Valve Insufficiency - diagnostic imaging; Tricuspid Valve Insufficiency - drug therapy; Tricuspid Valve Insufficiency - epidemiology; Vascular Surgery
• ISSN: 0172-0643; 1432-1971
• DOI: 10.1007/s00246-015-1154-0

Sildenafil, a phosphodiesterase-5 inhibitor, is a controversial treatment option for pulmonary arterial hypertension (PAH), a significant complication of bronchopulmonary dysplasia (BPD). The objective of this study was to evaluate the use of sildenafil in infants with PAH secondary to BPD. This was a retrospective review of medical records of all premature infants with PAH associated with BPD treated with sildenafil between January 2009 and May 2013 in a level 3 neonatal intensive care unit. The primary outcomes were clinical response (20 % decreases in respiratory support score or oxygen requirements) and echocardiographic response (20 % decrease in tricuspid regurgitation gradient or change of at least 1° of septal flattening). Twenty-three infants were included in the study. Significant echocardiographic and clinical responses were, respectively, observed in 71 and 35 % of cases. Most clinical responses were observed in the first 48 h of treatment, and the median time to an echocardiographic response was of 19 days. The median dose of sildenafil used was 4.4 mg/kg/day, with a median time to reach the maximum dose of 9 days. Transient hypotension was the primary reported side effect, and it was observed in 44 % of our study population. Sildenafil treatment in patients with PAH secondary to BPD was associated with an echocardiographic improvement in the majority of patients, whereas clinical improvement was observed in a minority of patients. Many infants presented with transient hypotension during the course of the treatment. Further prospective studies are required to better assess safety and efficacy of this treatment in this population.