title: Sildenafil Treatment of Infants With Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension.
abstract: OBJECTIVE
  This study had 2 goals: (1) to identify clinical and demographic characteristics associated with sildenafil exposure for infants with bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH); and (2) to characterize hospital-specific treatment frequency, age at first administration, and length of sildenafil treatment.
  
  
  METHODS
  This retrospective cohort study used data from the Pediatric Health Information System to determine variables associated with sildenafil exposure and between-hospital variations in sildenafil utilization patterns. The study included infants with BPD-PH who were discharged between January 1, 2006, and December 31, 2013.
  
  
  RESULTS
  Within 36 US pediatric hospitals, 3720 infants were diagnosed with BPD, of whom 598 (16%) also had a diagnosis of PH (BPD-PH). Among infants with BPD-PH, 104 infants (17%) received sildenafil. The odds for sildenafil treatment among infants born between 25 and 26 weeks' gestational age (GA) and <24 weeks' GA, respectively, were 2.26 (95% confidence interval [CI]: 1.20-4.24) and 3.21 (95% CI: 1.66-6.21) times those of infants born at 27 to 28 weeks' GA. Severity of BPD correlated with sildenafil exposure, with adjusted odds ratios (ORs) for moderate BPD (OR: 3.03 [95% CI: 1.03-8.93]) and severe BPD (OR: 7.56 [95% CI: 2.50-22.88]), compared with mild BPD. Greater rates of sildenafil exposure were observed among small for GA neonates (OR: 2.32 [95% CI: 1.21-4.46]). The proportion of infants with BPD-PH exposed to sildenafil varied according to hospital (median: 15%; 25th-75th percentile: 0%-25%), as did the median duration of therapy (52 days; 25th-75th percentile: 28-109 days).
  
  
  CONCLUSIONS
  The odds of sildenafil treatment were greatest among the most premature infants with severe forms of BPD. The frequency and duration of sildenafil exposure varied markedly according to institution. Patient-centered trials for infants with BPD-PH are needed to develop evidence-based practices.
authors.affiliation: The Heart Center at Nationwide Children's Hospital, Columbus, Ohio Center for Perinatal Research and Departments of Pediatrics, and Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, Ohio carl.backes@nationwidechildrens.org.
authors.forename: Carl H
authors.initials: CH
authors.lastname: Backes
authors.affiliation: Department of Economics and Center for Human Resource Research, The Ohio State University, Columbus, Ohio; and.
authors.forename: Patricia B
authors.initials: PB
authors.lastname: Reagan
authors.affiliation: Center for Developmental Therapeutics, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Charles V
authors.initials: CV
authors.lastname: Smith
authors.affiliation: Center for Perinatal Research and Departments of Pediatrics, and The Neonatal and Infant Feeding Disorders Research Program, Nationwide Children's Hospital Research Institute, Columbus, Ohio.
authors.forename: Sudarshan R
authors.initials: SR
authors.lastname: Jadcherla
authors.affiliation: Center for Perinatal Research and Departments of Pediatrics, and.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Slaughter
mesh_terms: D001997:Bronchopulmonary Dysplasia / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D020380:Needs Assessment; D010043:Outcome and Process Assessment, Health Care; D058986:Phosphodiesterase 5 Inhibitors / Q000008:administration & dosage; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D000068677:Sildenafil Citrate / Q000008:administration & dosage*; D014481:United States
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D000068677:Sildenafil Citrate