Severe persistent pulmonary hypertension of the newborn in a setting where limited resources exclude the use of inhaled nitric oxide: successful treatment with sildenafil.
We present the case of a full term neonate with severe persistent pulmonary hypertension of the newborn (PPHN) after birth asphyxia cared for at the St. Elizabeth Hospital in Curacao, Netherlands Antilles. Although the child was ventilated with high pressures and was given high doses of cardiovascular pressors, the arterial oxygen levels remained low with an alveolar-arterial O2 gradient of 651 mmHg. As a last resort, sildenafil (1.5 mg/kg) was given via a nasogastric tube. This resulted in an immediate and sustained elevation of arterial oxygenation and subsequent complete recovery. After administration of sildenafil there was a transient hypotension which was corrected by a single bolus of saline.


CONCLUSIONS
We discuss the current treatment modalities of persistent pulmonary hypertension of the newborn and the potential use of phosphodiesterase 5 inhibitors such as sildenafil in a situation where the standard of practice with inhaled nitric oxide and extracorporeal membrane oxygenation is not available.
Juliana
Amadu E
AE
Delfzicht Ziekenhuis, Jachtlaan 50, 9934 JD Delfzijl, The Netherlands. amadu@gmx.net
Abbad
Filomena C B
FC
D001993:Bronchodilator Agents / Q000191:economics / Q000600:supply & distribution; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D007231:Infant, Newborn; D008297:Male; D009569:Nitric Oxide / Q000191:economics / Q000600:supply & distribution; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use*; D010879:Piperazines / Q000627:therapeutic use*; D011687:Purines; D040841:Resource Allocation; D000068677:Sildenafil Citrate; D013450:Sulfones
D001993:Bronchodilator Agents; D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D009569:Nitric Oxide; D000068677:Sildenafil Citrate