Sildenafil citrate, bronchopulmonary dysplasia and disordered pulmonary gas exchange: any benefits?

OBJECTIVE: The objective of this study is to determine the effects that sildenafil citrate has on gas exchange in infants with bronchopulmonary dysplasia (BPD)-associated pulmonary hypertension (PH). STUDY DESIGN: A retrospective review was performed from 2005 to 2009. Infants treated with sildenafil citrate for greater than 48 h were included. Standard patient data was collected, including echocardiogram, inspired oxygen and systemic blood pressure, before and during administration of sildenafil citrate. RESULT: Sildenafil citrate was used in 21 preterm infants with BPD-associated PH. A significant reduction in estimated right ventricular peak systolic pressure was seen after initiation of sildenafil citrate, with the majority of infants showing no improvement in gas exchange at 48 h of treatment. Four infants died during treatment. CONCLUSION: Sildenafil citrate reduced estimated pulmonary artery pressures, but this reduction was not reflected in improved gas exchange within the first 48 h.

Palivizumab for respiratory syncytial virus prophylaxis.

Palivizumab, a humanized monoclonal antibody, has been approved by the FDA to prevent severe lower respiratory tract infections caused by RSV in high-risk patients. Prophylaxis of RSV infections with palivizumab requires monthly injections (15 mg/kg) during the RSV season. In the IMpact-RSV study, hospitalizations resulting from RSV decreased by 55% in the palivizumab treatment group. Palivizumab has also been shown to decrease the number of days with moderate or severe RSV infection, with an increased oxygen requirement, and ICU admissions. Palivizumab has been shown to be well tolerated with minimal adverse effects. The most frequently reported adverse effects were fever and minor injection site reactions. Determination of which patients should receive RSV prophylaxis should take into consideration all risk factors. Recommendations for RSV prophylaxis with RSV-IGIV and palivizumab have been published by the American Academy of Pediatrics. To date, no studies directly comparing RSV-IGIV and palivuzumab have been conducted. Neither product is recommended in children with congenital heart disease.

A guide to references on drugs and breastfeeding.

Many of the above references will provide the necessary information to determine the safety of drugs during breastfeeding. Because interpretation of existing data varies in these references, it is prudent to consult with more than one resource. References should be routinely updated every 1 to 2 years as new drugs and literature are made available.

Principles of drug transfer into breast milk and drug disposition in the nursing infant.

There are numerous factors to consider when assessing the safety of drugs in lactating women. Drug properties facilitating transfer into milk as well as the pharmacokinetic properties of the drug in the mother and infant must be evaluated. Drug properties which promote low milk concentrations are: large volume of distribution, high protein binding, low lipid solubility, ionization at physiologic pH and large molecular weight. Following transfer into breast milk, drugs with low bioavailability and short elimination half-lives in neonates have improved safety.

Respiratory syncytial virus-immunoglobulin intravenous (RSV-IGIV) for respiratory syncytial viral infections: part I.

RSV is a highly contagious, devastating disease, especially in high-risk infants. RSV infection typically presents as an upper respiratory tract infection and then may progress to the lower respiratory tract, causing pneumonia and bronchiolitis. The signs, symptoms, and severity of RSV infection vary with age and the number of previous RSV infections. Young age, premature birth, a crowded living environment, day care attendance, and exposure to passive smoking are risk factors for more severe RSV disease. Treatment of RSV infection consists primarily of supportive care but may also include bronchodilators and ribavirin. RSV-IGIV provides passive immunity against RSV infections. RSV-IGIV has been shown to decrease the incidence of RSV hospitalization by 41% to 65% and the number of hospital days by 53% to 59%. The use of RSV-IGIV has also decreased the occurrence and duration of moderate/severe RSV infection. RSV-IGIV has an FDA-approved indication for the prevention of RSV-LRTI in infants less than 24 months of age who have BPD or were born prematurely (< or = 35 weeks' gestational age). RSV-IGIV is not approved for use in children with CHD.