Efficacy of Milrinone Plus Sildenafil in the Treatment of Neonates with Persistent Pulmonary Hypertension in Resource-Li
- PDF / 934,143 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 19 Downloads / 140 Views
ORIGINAL RESEARCH ARTICLE
Efficacy of Milrinone Plus Sildenafil in the Treatment of Neonates with Persistent Pulmonary Hypertension in Resource‑Limited Settings: Results of a Randomized, Double‑Blind Trial Mamdouh El‑Ghandour1 · Bahaa Hammad1 · Mohamed Ghanem1 · Manal A. M. Antonios1
© Springer Nature Switzerland AG 2020
Abstract Background The management of severe persistent pulmonary hypertension (PPHN) can be very challenging in many resource-limited centers without access to inhaled nitric oxide or extracorporeal membrane oxygenation. Objectives The current study aimed to investigate the efficacy of oral sildenafil and intravenous milrinone infusion and compare the effects of these drugs in combination versus as monotherapy in neonates with PPHN. Methods A double-blind randomized controlled trial was conducted in which neonates with PPHN were divided into three groups of 20 patients each: group 1 received oral sildenafil starting at 0.5 mg/kg every 6 h to a target maintenance dose of 2 mg/kg every 6 h; group 2 received intravenous milrinone 0.5 μg/kg/min as a continuous infusion; and group 3 received both oral sildenafil and intravenous milrinone. Results Post-treatment pulmonary artery systolic pressure was significantly lower in group 3 than in groups 1 and 2, which both received monotherapy (p = 0.031). The oxygenation index also decreased significantly in the dual-therapy group (p = 0.002) compared with the monotherapy groups. Combined use of both drugs demonstrated a beneficial synergistic effect with better outcomes and reduced mortality. Conclusion Dual therapy using sildenafil and milrinone was superior to monotherapy with either drug in neonates with severe PPHN and is recommended for use in resource-constrained settings. Registration Pan African Clinical Trial Registry identifier number PACTR201902691230243.
1 Introduction A series of circulatory events takes place at birth to ensure a smooth transition from fetal to extrauterine life. Clamping of the umbilical cord removes low-resistance placental circulation and increases systemic arterial pressure. Simultaneously, various mechanisms operate to rapidly reduce pulmonary arterial pressure and increase pulmonary blood flow. * Manal A. M. Antonios [email protected] Mamdouh El‑Ghandour [email protected] Bahaa Hammad [email protected] Mohamed Ghanem [email protected] 1
Key Points Neonates with persistent pulmonary hypertension (PPHN) should ideally receive inhaled nitric oxide and extracorporeal membrane oxygenation. In newborn care units lacking this gold standard therapy for PPHN, treatment comprises pulmonary vasodilators such as oral sildenafil or continuous intravenous infusion of milrinone. In the current randomized controlled trial, sildenafil combined with milrinone was more effective at normalizing pulmonary artery pressure and improving survival rates than treatment with either of the two drugs as monotherapy.
Department of Pediatrics, Faculty of Medicine, El‑Shatby Hospital, Alexandria University, Alexandria,
Data Loading...
