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ADC-FNN Online First, published on February 25, 2015 as 10.1136/archdischild-2015-308164 PostScript
LETTER
Sildenafil in bronchopulmonary dysplasia: safe to use? One-third of preterm infants are diagnosed with bronchopulmonary dysplasia (BPD), a complex multifactorial disorder associated with significant morbidity. Associated pathologies include pulmonary hypertension (PH), a critical cardiorespiratory pathology with 48% 2-year mortality that affects up to a third of infants with BPD.1 Pulmonary vasodilatation in PH prolongs life, and phosphodiesterase-V inhibition is the primary approach for this.2 That stated, current evidence is limited to 45 patients across five case series.3 They demonstrate a reduction in overall mortality to 18%, but reservations remain regarding safety and efficacy. We therefore conducted a retrospective investigation into patients with BPD–PH managed at our centre between August 2008 and July 2014. BPD was defined as a neonatal oxygen requirement beyond 36 weeks. PH was suspected using transthoracic echocardiography-estimated systolic pulmonary artery pressure (PAP) >36 mm Hg (from the tricuspid peak Doppler-derived pressure drop and the modified Bernoulli equation). Oral sildenafil was dosed consistently at 0.5 mg/kg four times daily and was initiated within an intensive care setting. Data were analysed using GraphPad Prism and are presented as median (interquartile range).
Fourteen patients with BPD–PH received sildenafil (treated group), while five more were managed without sildenafil (untreated group). No patients were excluded. The decision to treat was based on individual clinician preference. Median gestation was 26 weeks (24–28 weeks) and age 69 days (32–157). Median treatment lasted 77.5 days (6–257.5). Fourteen patients (74%) had small arterial ducts, of which seven (50%) received an intervention during the treatment period. Patients received concomitant therapy including oxygen. One treated patient received epoprostenol, and one treated patient received nitric oxide. PH resolved in 10 treated (71%) and 2 untreated (40%) patients. In addition, two (14%) treated patients showed >20% reduction in PAP. Estimated systolic PAP pressures were significantly lower in patients on sildenafil than before treatment (31 vs 41 mm Hg; p
ADC-FNN Online First, published on February 25, 2015 as 10.1136/archdischild-2015-308164 PostScript
LETTER
Sildenafil in bronchopulmonary dysplasia: safe to use? One-third of preterm infants are diagnosed with bronchopulmonary dysplasia (BPD), a complex multifactorial disorder associated with significant morbidity. Associated pathologies include pulmonary hypertension (PH), a critical cardiorespiratory pathology with 48% 2-year mortality that affects up to a third of infants with BPD.1 Pulmonary vasodilatation in PH prolongs life, and phosphodiesterase-V inhibition is the primary approach for this.2 That stated, current evidence is limited to 45 patients across five case series.3 They demonstrate a reduction in overall mortality to 18%, but reservations remain regarding safety and efficacy. We therefore conducted a retrospective investigation into patients with BPD–PH managed at our centre between August 2008 and July 2014. BPD was defined as a neonatal oxygen requirement beyond 36 weeks. PH was suspected using transthoracic echocardiography-estimated systolic pulmonary artery pressure (PAP) >36 mm Hg (from the tricuspid peak Doppler-derived pressure drop and the modified Bernoulli equation). Oral sildenafil was dosed consistently at 0.5 mg/kg four times daily and was initiated within an intensive care setting. Data were analysed using GraphPad Prism and are presented as median (interquartile range).
Fourteen patients with BPD–PH received sildenafil (treated group), while five more were managed without sildenafil (untreated group). No patients were excluded. The decision to treat was based on individual clinician preference. Median gestation was 26 weeks (24–28 weeks) and age 69 days (32–157). Median treatment lasted 77.5 days (6–257.5). Fourteen patients (74%) had small arterial ducts, of which seven (50%) received an intervention during the treatment period. Patients received concomitant therapy including oxygen. One treated patient received epoprostenol, and one treated patient received nitric oxide. PH resolved in 10 treated (71%) and 2 untreated (40%) patients. In addition, two (14%) treated patients showed >20% reduction in PAP. Estimated systolic PAP pressures were significantly lower in patients on sildenafil than before treatment (31 vs 41 mm Hg; p
