title: Oral sildenafil and inhaled iloprost in the treatment of pulmonary hypertension of the newborn.
abstract: OBJECTIVE
  This study was performed to examine the effectiveness and safety of oral sildenafil and inhaled iloprost in term newborns with persistent pulmonary hypertension of the newborn (PPHN).
  
  
  METHODS
  Oral sildenafil and inhaled iloprost were administered to 27 and 20 neonates, respectively, for treatment of persistent pulmonary hypertension. All patients were term infants at 37 gestational weeks or older. In the sildenafil group, 14 patients had meconium aspiration syndrome, 8 had asphyxia (hypoxic ischemic encephalopathy stages II and III), 3 had congenital pneumonia, 1 had transient tachypnea, and 1 had idiopathic PPHN. In the iloprost group, 9 patients had meconium aspiration syndrome, 7 had asphyxia (hypoxic ischemic encephalopathy stages II and III), 3 had congenital pneumonia, and 1 had transient tachypnea. Sildenafil citrate was administered via an oral feeding tube. Iloprost was administered endotracheally to patients on mechanical ventilation using a jet nebulizer.
  
  
  RESULTS
  Iloprost appeared to be more effective than sildenafil in the treatment of PPHN with regard to time to adequate clinical response, ventilatory parameters, duration of drug administration, duration of mechanical ventilation, duration of return to normal values of respiratory failure indices, use of MgSO4 as a second vasodilator and requirement for support with inotropic agents. We observed no side effects on blood pressure or homeostasis in any of the patients in the iloprost group. Systemic hypotension was significantly elevated in the sildenafil group. Four and three infants died of PPHN in the sildenafil and iloprost groups, respectively. Pulmonary systolic arterial pressure decreased to normal levels in the remaining 40 patients, and they were discharged from hospital.
  
  
  CONCLUSIONS
  We suggested that inhaled iloprost may be a safe and effective treatment choice in newborn infants with persistent pulmonary hypertension. In cases where treatment with inhaled iloprost, ECMO or INO is not possible, oral sildenafil can be an alternative therapy option in the treatment of PPHN.
authors.affiliation: Division of Neonatal Intensive Care Unit, Erzurum District Training and Research Hospital, Erzurum, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Kahveci
authors.forename: Osman
authors.initials: O
authors.lastname: Yilmaz
authors.forename: Ummu Zeynep
authors.initials: UZ
authors.lastname: Avsar
authors.forename: Murat
authors.initials: M
authors.lastname: Ciftel
authors.forename: Omer
authors.initials: O
authors.lastname: Kilic
authors.forename: Fuat
authors.initials: F
authors.lastname: Laloglu
authors.forename: Kezban
authors.initials: K
authors.lastname: Ozturk
mesh_terms: D000284:Administration, Oral; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy*; D020925:Hypoxia-Ischemia, Brain / Q000150:complications; D016285:Iloprost / Q000627:therapeutic use*; D007231:Infant, Newborn; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000150:complications; D009330:Nebulizers and Vaporizers; D011014:Pneumonia / Q000150:complications / Q000151:congenital; D012189:Retrospective Studies; D000068677:Sildenafil Citrate / Q000627:therapeutic use*; D059246:Tachypnea / Q000150:complications; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D000068677:Sildenafil Citrate; D016285:Iloprost
keywords: iloprost; newborn; pulmonary hypertension; sildenafil