Variable clinical and hemodynamic effect of sildenafil in extreme premature infants with bronchopulmonary dysplasia-associated pulmonary hypertension.

OBJECTIVES

To explore the clinical and hemodynamic effects of sildenafil in extreme premature population with bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PH).

STUDY

DESIGN

Single-centre retrospective study on infants born <28 weeks with BPD-PH on sildenafil. The respiratory severity score was assessed at four time points (72 h-4wks). Echocardiographic data were compared before and after sildenafil.

RESULTS

Sixty-four infants were included. The mean gestational age was 26.1 ± 1.6 weeks. 30(47%) infants showed improvement in RSS, 17(26%) had no change and 17(26%) showed poor RSS. 15(88) in the poor RSS group had an early onset PH. The improved RSS group reduced tricuspid regurgitation (3.3 ± 0.6 to 2.7 ± 0.5 m/s, p = 0.007). The pulmonary acceleration time (PAAT), PAAT/RVET (right ventricular ejection time), and RV fractional area change showed improvement in all groups. The poor RSS group had high pretreatment systolic blood pressure (90.7 ± 8.8 vs 82.7 ± 4.4 mmHg, p = 0.04).

CONCLUSION

Variable clinical response to sildenafil warrants close monitoring of respiratory status.