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2006, Número 4

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Rev Mex Pediatr 2006; 73 (4)


Sildenafil oral como alternativa en el tratamiento de recién nacidos con hipertensión pulmonar persistente

Herrera TR, Concha GP, Holberto CJ, Loera GRG, Rodríguez BI

Idioma: Español
Referencias bibliográficas: 33
Paginas: 159-163
Archivo PDF: 53.85 Kb.


RESUMEN

Objetivo: Comparar la respuesta de niños recién nacidos con hipertensión pulmonar persistente (HPP) tratados con sildenafil oral y manejo rutinario vs sólo el manejo de rutina.
Material y métodos: Escogidos en forma aleatoria 13 neonatos con (HPP) recibieron sildenafil (Viagra®) vía oral además de ventilación: a razón de 2 mg/kg/dosis cada 6 horas, y a otros 11 se les dio agua bidestilada cada 6 horas; estos últimos fueron manejados con gases y manejo convencional. Se monitorizó el índice de oxigenación, gases sanguíneos y presión media de la vía aérea.
Resultados: El grupo tratado con sildenafil mejoró la oxigenación a partir de las 24 h de tratamiento, disminuyendo el gradiente alvéolo-arterial y mejorando el índice de oxigenación, lo que permitió disminuir rápidamente los parámetros ventilatorios y la presión media de la vía aérea disminuyendo el riesgo de neumotórax y mejorando la sobrevida.
Conclusión: La administración oral de sildenafil en recién nacidos con HHP es una buena alternativa en los hospitales que no cuentan con óxido nítrico y/o alta frecuencia oscilatoria.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Fox W, Duara S. Persistent pulmonary hypertension in the neonate: diagnosis and management. J Pediatr 1983; 103: 505-14.

  2. Donoso F, Moro M. Hipertensión pulmonar persistente del recién nacido. An Esp Pediatr 1990; 33: 101-5.

  3. Bifano EM, Pfannenstiel A. Duration of hyperventilation and outcome in infants with persistent pulmonary hypertension. Pediatr 1988; 81: 657-61.

  4. Roberts JD, Shaul PW. Advances in the treatment of persistent pulmonary hypertension of the newborn. Pediatr Clin N Amer 1993; 40: 983-1004.

  5. Walsh-Sukys MC, Cornell DJ, Houston LN, Keszler M, Kanto WP. Treatment of persistent hypertension of the newborn without hyperventilation: an assessment of diffusion of innovation. Pediatr 1994; 94: 307-9.

  6. Walsh-Sukys M, Wright L. Persistent pulmonary hypertension of the newborn (PPHN): prospective, multicenter study of treatments and outcome. Pediatr Res 1995; 37: 244A.

  7. Kinsella JP, Abman SH. Recent developments in the pathophysiology and treatment of persistent pulmonary hypertension of the newborn. J Pediatr 1995; 126: 853-854.

  8. Clark RH, Kueser TJ, Walker MW, Southgate WM, Huckaby JL, Perez JA et al. Low dose nitric oxide therapy for persistent pulmonary hypertension of the newborn. N Engl J Med 2000; 342: 469-74.

  9. The Neonatal Inhaled Nitric Oxide Study Group. A Inhaled nitric oxide in full-term and nearly full-term infants with hypoxic respiratory failure. N Engl J Med 1997; 336: 597-604.

  10. The Neonatal Inhaled Nitric Oxide Study Group (NINOS): B Inhaled nitric oxide and hypoxic respiratory failure in infants with congenital diaphragmatic hernia. Pediatr 1997; 99: 838-45.

  11. Davidson D, Barefield ES, Kattwinkel J, Dudell G, Damask M, Straube R, Rhines J, Chang CT, I-NO/PPHN Study Group: Inhaled nitric oxide for the early treatment persistent pulmonary hypertension of the term newborn: a randomized, double-masked, placebo-controlled, dose-response, multicenter study. Pediatr 1998; 101: 325-34.

  12. Kinsella JP, Truog WE, Walsh WF, Goldberg RN, Bancalari E, Mayock DE et al. Randomized, multicenter trial of inhaled nitric oxide and high-frequency oscillatory ventilation in severe, persistent pulmonary hypertension of the newborn. J Pediatr 1997; 131: 55-62.

  13. Kinsella JP, Walsh WF, Bose CL, Gertsmann DR, Labella JJ, Sardesai S et al. Inhaled nitric oxide in premature neonates with severe hypoxaemic respiratory failure: A randomized controlled trial. Lancet 1999; 354: 1061-5.

  14. Kinsella JP, Abman SH. Clinical approach to inhaled nitric oxide therapy in the newborn with hypoxemia. J Pediatr 2000; 136: 717-26.

  15. Drummond WH, Gregory GA, Heymann MA, Phibbs RA. The independent effects of hyperventilation, tolazoline, and dopamine on infants with persistent pulmonary hypertension. J Pediatr 1981; 98: 603-11.

  16. Welch JC, Bridson JM, Gibbs JL. Endotracheal tolazoline for severe persistent pulmonary hypertension of the newborn. Br Heart J 1995; 73: 99-100.

  17. Tolsa JF, Cotting J, Sekarski N, Payot M, Micheli JL, Calame A. Magnesium sulphate as an alternative and safe treatment for severe persistent pulmonary hypertension of the newborn. Archiv Dis Child Fetal Neonat 1995; 72: F184-7.

  18. Wu TJ, Teng RJ, Tsou KI. Persistent pulmonary hypertension of the newborn treated with magnesium sulfate in premature neonates. Pediatr 1995; 96: 472-4.

  19. Abu-Osba YK, Manasra K, Galal O, Rejjal A. Treatment of pulmonary hypertension of newborn with magnesium. Pediatr Res 1990; 27: 294A.

  20. Atz AM, Wessel DL. Sildenafil ameliorates effects of inhaled nitric oxide withdrawal. Anesthesiology 1999; 91: 307-10.

  21. Weimann J, Ullrich R, Hromi J, Fujino Y, Clark MW, Bloch KD et al. Sildenafil is a pulmonary vasodilator in awake lambs with acute pulmonary hypertension. Anesthesiology 2000; 92: 1702-12.

  22. Shekerdemian LS, Ravn HB, Penny DJ. Intravenous sildenafil lowers pulmonary vascular resistance in a model of neonatal pulmonary hypertension. Am J Resp & Critical Care Medicine 2002; 165(8): 1098-1102.

  23. Lepore JJ, Maroo A, Pereira NL, Ginns LC, Dec GW, Zapol WM et al. Effect of sildenafil on the acute pulmonary vasodilator response to inhaled nitric oxide in adults with primary pulmonary hypertension. Am J Cardiology 2002; 90(6): 97-9.

  24. Ichinose F, Erana-Garcia J, Hromi J, Raveh Y, Jones R, Krim L et al. Nebulized sildenafil is a selective pulmonary vasodilator in lambs with acute pulmonary hypertension. Critical Care Medicine 2001; 5: 1000-5.

  25. Abrams D, Schulze-Neick I, Magee AG. Sildenafil as a selective pulmonary vasodilator in childhood primary pulmonary hypertension. Heart 2000; 84: e4.

  26. Zhao L, Mason N, Morell N, Kojonazarov B, Sadykov A, Maripov A et al. Sildenafil inhibits hypoxia-induced pulmonary hypertension. Circulation 2001; 104: 424-8.

  27. Michelakis E, Tymchak W, Lien D, Webster L, Hashimoto K, Archer S. Oral sildenafil is an effective and specific vasodilator in patients with pulmonary arterial hypertension; comparison with inhaled nitric oxide. Circulation 2002; 105: 2398-403.

  28. Ghofrani HA, Wiedemann R, Rose F, Olschewski H, Schermuly RT, Weissmann N et al. Combination therapy with oral sildenafil and inhaled nitric oxide for severe pulmonary hypertension. Ann Intern Med 2002; 136: 515-22.

  29. Bigatello LM, Hess D, Dennehy KC, Medoff BD, Hurford WE. Sildenafil can increase the response to inhaled nitric oxide. Anesthesiology 2000; 92: 1827-9.

  30. Dukarm RC, Russell JA, Monn FC III, Peny BJ, Steinhorn RH. The cGMP-specific phosphodiesterase inhibitor E4021 dilates the pulmonary circulation. Am J Respir Crit Care Med 1999; 160: 858-65.

  31. Kleinsasser A, Loeckinger A, Hoermann C, Puehringer F, Mutz N, Bartsch G et al. Sildenafil modulates hemodynamics and pulmonary gas exchange. Am J Respir Crit Care Med 2001; 163: 339-343.

  32. Prasad S, Wilkinson J, Gatzoulis MA. Sildenafil in primary pulmonary hypertension. N Engl J Med 2000; 343: 1342-43.

  33. Dworetz AR, Moya FR, Sabo B, Gladstone I, Gross I. Survival of infants with persistent pulmonary hypertension without extracorporeal membrane oxygenation. Pediatr 1989; 84: 1-6.




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