Hamad Medical Corporation Rövid összefoglaló This study hopes to evaluate the effectiveness of early combined use of Sildenafil and nitric oxide iNO in newborns with Persistent pulmonary hypertension PPHN and or hypoxemic respiratory failure and assess whether this would improve oxygenation, improve time on mechanical ventilation for these babies and also prevent rebound hypoxic episodes.
Részletes leírás PPHN is characterized by hyper reactivity of the muscle layer in pulmonary arteriole hipertónia and right to left shunt across the ductus arteriosus and the foramen ovale in the absence of structural heart defects.
It could also include right ventricle dysfunction in many cases.
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The reported incidence of this disease is 0. The main objective of therapy in PPHN is to reduce pulmonary vascular resistance.
4.4 Cardiovascular: Resistance of the Arterioles
To this purpose, inhaled nitric oxide has been used in developed and several under developed countries. Extra corporeal membrane oxygenation is also useful but is an invasive therapy in PPHN with serious adverse effects reported.
Sildenofil in Persistent Pulmonary Hypertension in Newborns
Recently Sildenafil has been evaluated as an alternative or adjunctive pulmonary vasodilator. It inhibits phosphodiesterase type 5 and elevates the concentration of cyclic guanosine monophosphate in the muscle cells of pulmonary vessels, which in turn decreases pulmonary vascular resistance.
Recently 3 clinical trials have evaluated Sildenafil versus Placebo or control in newborns with PPHN,all of them showing a significant improvement in arteriole hipertónia index, decreased mortality and reduced arteriole hipertónia of rebounds after discontinuing iNO. The use of Sildenafil in treating PPHN secondary to Chronic lung disease in older infants had been receiving significant attention over the last few years. In this study arteriole hipertónia investigators plan to compare the effectiveness of the use of early combined Sildenafil and iNO in newborns with PPHN and or hypoxemic respiratory failure and whether it would improve oxygenation, decrease the time spent in mechanical ventilation and prevent rebound hypoxic episodes.