Document Detail


Cardiovascular effects of sildenafil in neonates and infants with congenital diaphragmatic hernia and pulmonary hypertension.
MedLine Citation:
PMID:  17344658     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pulmonary hypertension is a common problem in patients with congenital diaphragmatic hernia (CDH). In a subset of these patients, pulmonary hypertension persists despite optimized ventilatory management and supportive care. Sildenafil, a phosphodiestrase V inhibitor, has been used in the treatment of pulmonary hypertension in adults and children. Cardiovascular effects of sildenafil in patients with CDH and pulmonary hypertension are not known. OBJECTIVE: To describe the changes in cardiovascular and respiratory parameters in newborn infants with CDH and persistent pulmonary hypertension refractory to inhaled nitric oxide (iNO) during the first 2 weeks of sildenafil administration. METHODS: Retrospective data analysis of seven patients with CDH (birth weight = 2,573 +/- 1,019 g; gestational age = 35.6 +/- 4.3 weeks) receiving oral sildenafil for pulmonary hypertension refractory to iNO. Findings of serial echocardiograms and data on cardiovascular and respiratory status were assessed. RESULTS: Right cardiac output increased and left cardiac output tended to increase 1.5-4 h after initiation of sildenafil and the increase was sustained throughout the study. Echocardiographic indices of pulmonary hypertension showed an apparent reduction in abnormally high pulmonary vascular resistance. Systemic blood pressure tended to decrease. Shortening fraction did not change. Ventilatory index and the need for iNO tended to decrease in the five surviving infants. CONCLUSIONS: These preliminary findings suggest that sildenafil may improve cardiac output by reducing pulmonary hypertension refractory to iNO in patients with CDH.
Authors:
Shahab Noori; Philippe Friedlich; Pierre Wong; Arlene Garingo; Istvan Seri
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Publication Detail:
Type:  Journal Article     Date:  2006-11-20
Journal Detail:
Title:  Neonatology     Volume:  91     ISSN:  1661-7800     ISO Abbreviation:  -     Publication Date:  2007  
Date Detail:
Created Date:  2007-03-08     Completed Date:  2007-04-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101286577     Medline TA:  Neonatology     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  92-100     Citation Subset:  IM    
Affiliation:
USC Division of Neonatal Medicine, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA. snoori@chla.usc.edu
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Blood Flow Velocity / drug effects
Blood Pressure / drug effects,  physiology
Cardiac Output / drug effects*,  physiology
Electrocardiography
Hernia, Diaphragmatic* / complications,  physiopathology
Humans
Hypertension, Pulmonary / complications,  drug therapy*,  physiopathology
Infant
Infant, Newborn
Phosphodiesterase Inhibitors / therapeutic use*
Piperazines / therapeutic use*
Pulmonary Artery / drug effects,  physiology
Purines / therapeutic use
Retrospective Studies
Sulfones / therapeutic use*
Vascular Resistance / drug effects
Vasodilator Agents / therapeutic use*
Chemical
Reg. No./Substance:
0/Phosphodiesterase Inhibitors; 0/Piperazines; 0/Purines; 0/Sulfones; 0/Vasodilator Agents; 139755-83-2/sildenafil

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