बाल चिकित्सा अनुसंधान में प्रगति
खुला एक्सेस

अमूर्त

Efficacy of Inhaled Nitric Oxide and Intragastric Sildenafil in Treatment of Persistent Pulmonary Hypertension of Newborn (PPHN) on High Frequency Oscillatory Ventilation (HFOV)

Rajiv Parapurath*, Madan Samuel

Background: Optimizing management of Persistent Pulmonary Hypertension of Newborn (PPHN) continues following availability of oral and intravenous Phosphodiesterase-V inhibitors. Study queried whether High Frequency Oscillatory Ventilation (HFOV) coupled with pulmonary vasodilators improves outcomes in neonates with severe- PPHN.

Objective: To prospectively evaluate efficacy of inhaled Nitric Oxide (iNO) and intra Gastric Sildenafil (iGS) in neonates with severe-PPHN on HFOV and exogenous surfactant.

Methods: Eighty-four consecutive neonates with severe-PPHN on HFOV and exogenous surfactant were treated with iNO (n=40) or iGS (n=44). Primary (28 days) outcomes analysed were adverse events, failure rate and mortality. Secondary (24 months) outcomes were neurological impairment, sensorineural deafness and chronic lung disease. At age 2 years neurodevelopmental evaluation by Bayley Scales of Infant and Toddler Development (Bayley-III^UK) was performed.

Results: Adverse events (44%) occurred in iNO-(30%) versus (57%)-iGS (p=0.030). Failure rate (14%) was seen in iNO-0% versus 27%-iGS (p=0.001). Mortality rate (4%) was iNO-8% versus 0%-iGS (p=0.001). Neurological impairment (19%) ensued in iNO-32% versus 7%-iGS (p=0.001). Sensorineural deafness (4%) happened in iNO- 5% versus 2%-iGS (p=0.04). Chronic lung disease (5%) was observed in iNO-8% versus 2%-iGS (p=0.02). Normal neurological outcome occurred in 81%, iNO-68% versus 93%-iGS (p=0.010). Bayley-IIIUK scores at age 2-years were normal (108-116) in 81%, mild impairment (71-75) ensued in 10% and moderate to severe delay (57-62) occurred in 9%.

Conclusion: Intra-gastric sildenafil was as efficacious as inhaled nitric oxide in treating severe-PPHN in neonates on HFOV and exogenous surfactant. In 81% of children at age 2-years normal neurodevelopment followed, irrespective of adjuvant treatment modalities.