Sildenafil in neonates

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  1. sativa Well-Known Member

    Sildenafil in neonates


    OBJECTIVE: To evaluate the safety of intravenous (IV) sildenafil, an inhibitor of cyclic guanosine monophosphate-specific phosphodiesterase, in treating near-term and term newborns with persistent pulmonary hypertension of the newborn (PPHN). STUDY DESIGN: This was an open-label, dose-escalation trial in newborns with PPHN and an oxygenation index (OI) 15. Sildenafil was delivered by continuous IV infusion for at least 48 hours and up to 7 days. RESULTS: Five centers enrolled a total of 36 neonates with PPHN at a mean of 34 /- 17 hours of age; 29 of these neonates were already receiving inhaled nitric oxide (i NO). A significant improvement in OI (28.7 to 19.3; P = .0002) was observed after 4 hours of sildenafil infusion in the higher dose cohorts. Thirty-five neonates survived; 1 neonate required extracorporeal membrane oxygenation (ECMO) support. In 4 neonates, sildenafil was stopped due to adverse events. Fax 41 61 306 12 34E-Mail [email protected] Paper Neonatology 2007;–100 DOI: 10.1159/000097125 Cardiovascular Effects of Sildenafil in Neonates and Infants with Congenital Diaphragmatic Hernia and Pulmonary Hypertension Shahab Noori a Philippe Friedlich a Pierre Wong b Arlene Garingo a Istvan Seri a a USC Division of Neonatal Medicine and b Division of Cardiology, Department of Pediatrics, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, Calif. 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. Ventilatory index and the need for i NO tended to decrease in the five surviving infants. Echocardiographic indices of pulmonary hyperten-sion showed an apparent reduction in abnormally high pul-monary vascular resistance. Conclusions: These preliminary findings suggest that sildenafil may improve cardiac output by re-ducing pulmonary hypertension refractory to i NO in pa-tients with CDH. Karger AG, Basel Introduction Congenital diaphragmatic hernia (CDH) is a relative-ly common anomaly with an incidence of approximately 1 in 4,000 life birth. A significant number of newborns with CDH that are symptomatic at birth have suprasys-temic pulmonary pressure [1] . The pathogenesis of pul-monary hypertension in CDH is multifactorial and in-cludes pulmonary vascular and parenchymal hypoplasia and maldevelopment and abnormal surfactant function [2] . Key Words Nitric oxide  Echocardiogram  Cardiac function Abstract Background: Pulmonary hypertension is a common prob-lem in patients with congenital diaphragmatic hernia (CDH). In a subset of these patients, pulmonary hypertension per-sists despite optimized ventilatory management and sup-portive care. Sildenafil, a phosphodiestrase V inhibitor, has been used in the treatment of pulmonary hypertension in adults and children.

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    Full-term neonates at Initially, 20 mg PO twice daily 40 mg/day or 60 mg/day PO as a singlestatus asthmaticusSildenafil for pulmonary hypertension This leaflet is about the use of sildenafil for. Persistent pulmonary hypertension of the newborn PPHN is a life-threatening neonatal pathology resulting from poor hemodynamic and respiratory transition. We describe here a neonate with severe pulmonary hypertension in whom the introduction of oral sildenafil in addition to inhaled NO led to control of the.

    The content of this evidence summary was up-to-date in March 2016. See summaries of product characteristics (SPCs), British national formulary (BNF), BNF for children (BNFc) or the MHRA or NICE websites for up-to-date information. There is evidence from small, short‑term randomised controlled trials (RCTs) in resource‑limited settings where nitric oxide is not available that oral sildenafil reduces mortality and improves physiological parameters of oxygenation compared with placebo in term or near‑term neonates with persistent pulmonary hypertension of the newborn (PPHN). However, there is very little evidence of sildenafil use for PPHN in settings such as the UK where inhaled nitic oxide is available. In a small RCT in premature neonates at risk of bronchopulmonary dysplasia (BPD) sildenafil was not beneficial, and it remains unclear if sildenafil leads to improved outcomes in premature neonates with BPD‑associated pulmonary hypertension. The long‑term safety of sildenafil in neonates with pulmonary hypertension is not known. This topic was prioritised following a request for an evidence review from the Neonatal and Paediatric Pharmacists Group because the use of sildenafil for pulmonary hypertension in neonates varies across centres in the UK. Pulmonary hypertension in neonates represents a heterogeneous group of diagnoses, including PPHN, which are associated with a 10% to 20% mortality rate (Perez and Laughon 2015). Nov 8, 2018 - transplant and progression of symptoms (1). Chez tous les patients, la classe fonctionnelle de la NYHA ne s'améliorait pas avec la ..... A major limitation of the present prospective observational study is the small ... Official Full-Text Paper (PDF): Oral tolerance in neonates: From basics to potential prevention of allergic ... development in breast-fed children, supporting a possible role ..... propose the opposite approach: deliberate exposure to dietary. Apr 13, 2018 - Studies in Europe, North America, and Australia all highlight that ... The multifactorial etiologies of hypotension in preterm neo-. In pathological conditions such as hypoxia and sepsis, poor ... J Ayub Med Coll Abbottabad 2017;29(4) CASE SERIES ORAL SILDENAFIL USE IN NEONATES WITH PERSISTENT PULMONARY HYPERTENSION OF NEWBORN Ali Shabbir Hussain, Rehan Ali, Shakeel Ahmed, Farah Naz, Anila Haroon Department of Pediatrics and Child Health, The Aga khan University Hospital Karachi-Pakistan Background: The prevalence of PPHN has been estimated at 1. live births.

    Sildenafil in neonates

    Oral Sildenafil in Infants With Persistent Pulmonary Hypertension of., Is Sildenafil an Effective Therapy in the Management of Persistent.

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  4. Oral Sildenafil in Infants With Persistent Pulmonary. Hypertension of the Newborn A Pilot Randomized. Blinded Study. Hernando Baquero, MDa, Amed Soliz.

    • Oral Sildenafil in Infants With Persistent Pulmonary. - Pediatrics.
    • Sildenafil in neonatal pulmonary hypertension due to impaired..
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    Mar 29, 2016. Summary of the evidence on sildenafil for treating pulmonary hypertension in neonates to inform local NHS planning and decision-making. Sildenafil may have the potential to improve physiological parameters and to improve mortality among neonates with pulmonary hypertension in settings where. Aug 4, 2017. Review question. Is sildenafil safe and effective in newborn babies with pulmonary hypertension ? Background. When a baby is born, pressure.

     
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