Sildenafil, a selective phosphodiesterase-5 (PDE5) inhibitor, shows promise in treating PPHN by improving pulmonary vascular tone. It achieves this by increasing levels of cyclic guanosine monophosphate (cGMP), leading to pulmonary vasodilation and reduced pulmonary vascular resistance.
Dosage and Administration
Typical sildenafil dosing for neonates with PPHN ranges from 0.1 to 0.5 mg/kg, administered intravenously every 6-12 hours. Precise dosing depends on the infant’s weight and clinical response, requiring close monitoring of oxygen saturation, blood pressure, and cardiac function. Adjustments are made based on observed effects.
Efficacy and Safety Considerations
Studies indicate sildenafil can significantly improve oxygenation and reduce the need for extracorporeal membrane oxygenation (ECMO) in some infants with PPHN. However, potential side effects include hypotension, apnea, and gastrointestinal upset. Continuous monitoring is crucial to mitigate these risks. Benefits must be weighed against potential adverse events on a case-by-case basis.
Monitoring and Management
Continuous pulse oximetry and blood pressure monitoring are necessary throughout treatment. Regular assessment of cardiac function via echocardiography is also recommended to detect potential complications. Close collaboration between neonatologists, cardiologists, and respiratory therapists ensures optimal management.
