Efficacy of inhaled nitric oxide combined with oral sildenafil on persistent pulmonary hypertension in the newborn infants / 中国小儿急救医学

ABSTRACT

Objective To evaluate the effects of inhaled nitric oxide(iNO)combined with oral sil-denafil therapy in the newborn infants with persistent pulmonary hypertension(PPHN).Methods Forty-six neonates with PPHN were devided into group A(n ﹦23)and group B(n ﹦23).The combined treatment of iNO and oral sildenafil was used in group A,and iNO was used in group B.During the therapy,the following factors were monitoredblood gas analysis,systolic blood pressure(SBP),systolic pulmonary artery pressure (SPAP),inspired oxygen fraction (FiO2 ),iNO concentration,iNO duration,ventilation time and hospital stay.The effective rate,mortality and the risk of pneumothorax,intraventricular hemorrhage,pulmonary hem-orrhage,bronchopulmonary dysplasia were compared between the two groups.All patients were treated in the same neonatal unit and received the same standard therapy throughout the study period.Results The effec-tive rates of group A and group B were 87.0%(20 /23)and 78.3%(18 /23)respectively.There was no sig-nificant difference between the two groups(χ2 ﹦0.15,P 〉0.05).The levels of SPAP/SBP decreased signifi-cantly,and the levels of PaO2 /FiO2 rised significantly at baseline 30 min,6 h and after the treatment.But there were no significant differences between the two groups(P 〉0.05).In group A,the iNO concentration stared at ≥15 ×10 -6 for 14 infants,〉15 ×10 -6 for 6 infants,which were lower than those in the group B (χ2 ﹦6.71 ,P 〈0.05).The iNO would be stopped when the concentration reached 40 ×10 -6 without any sign of improvement.Compared to group B,the duration of iNO[(57.3 ±27.8)h vs.(87.7 ±47.0)h],the ven-tilation time[(94.44 ±31 .88)h vs.(123.20 ±47.43)h],and the time of hospital stay[(14.55 ±3.19)d vs.(18.78 ±4.60)d]in group A were shorter(P 〈0.05),whereas the mortality and the incidence of pneu-mothorax,intraventricular hemorrhage,pulmonary hemorrhage and bronchopulmonary dysplasia had not sig-nificantly differences between the two groups.Conclusion The effects of iNO combined with oral sildenafil in the newborn infants with PPHN was same compared to iNO.But it can effectively reduced the iNO concen-tration and shorten the duration of iNO,the ventilation time and the hospital stay without augmentation of risk of mortality,pneumothorax,intraventricular hemorrhage,pulmonary hemorrhage,bronchopulmonary dysplasia in neonatal patients.