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Riaz Ahmed Shah, Muhammad Iqbal


Every 7 out of 1000 live births experience Persistent pulmonary hypertension (PPHN). The rate of deaths is high but is reduced to around 15% with the use of inhalation of nitric oxide, surfactant and ventilation of the high frequency type. Selective decrease in the pulmonary vascular resistance is achieved with Sildenafil, which is a phosphodiesterase inhibitor of kind. The best to treat neonates suffering from hypertension of the pulmonary type is inhalation of nitric oxide including vasodilator of the pulmonary type. Sildenafil taken orally is a good prospective solution to the problem but it hasn’t been methodically assessed in babies with PPHN. Material & Methods: All patients who fulfilled the inclusion criteria and visited to department of pediatrics, Ziauddin University Hospital, Karachi were included in the study. Informed consent was taken from parents / guardian after explaining the procedure, risks and benefits of the study. Sildenafil tablet (50 mg) was crushed and reconstituted with distilled water and then stored in a plastic container in a refrigerator at 5°C. Oral sildenafil was given as per study protocol with a starting dose of 0.5 mg/kg/dose and increased by 0.5 mg/kg/dose to a maximum of 2 mg/kg/dose after assessing every 6 h if non-responsive. OI, oxygen saturations (SpO), alveolar-arterial oxygen gradient (A-aDO2), a/A ratio, and SOPI (for non-invasive ventilated babies) were monitored serially every 6 hours. Results: Mean ± SD of gestational age was 38.5±8.39 with C.I (37.4 to 39.5) weeks. Mean ± SD of birth weight was 3215±348 with C.I (3172.8 to 3257.1) grams. Efficacy of oral sildenafil was noted in 208 (78.78%) patents while 56 (21.22%) was found to be non-effective (P-value<0.001*). Conclusion: It is to be concluded that the efficacy of oral sildenafil in maintenance of persistent pulmonary hypertension was found to be effective and underscores the need for a large, controlled trial. Keywords: Neonates, Oral Sildenafil, Efficacy, Persistent pulmonary Hypertension.


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