Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
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Oral Sildenafil in Persistent Pulmonary Hypertension of the Newborn

신생아의 지속성 폐동맥 고혈압증에서 Sildenafil 치료 경험

  • Son, Su-Bin (Department of Pediatrics, Cheil General Hospital and Women’s Healthcare Center, Kwandong University College of Medicine) ;
  • Kim, Kyung-Ah (Department of Pediatrics, Cheil General Hospital and Women’s Healthcare Center, Kwandong University College of Medicine) ;
  • Yun, So-Young (Department of Pediatrics, Cheil General Hospital and Women’s Healthcare Center, Kwandong University College of Medicine) ;
  • Ko, Sun-Young (Department of Pediatrics, Cheil General Hospital and Women’s Healthcare Center, Kwandong University College of Medicine) ;
  • Lee, Yeon-Kyung (Department of Pediatrics, Cheil General Hospital and Women’s Healthcare Center, Kwandong University College of Medicine) ;
  • Shin, Son-Moon (Department of Pediatrics, Cheil General Hospital and Women’s Healthcare Center, Kwandong University College of Medicine)
  • 손수빈 (관동대학교 의과대학 제일병원 소아청소년과) ;
  • 김경아 (관동대학교 의과대학 제일병원 소아청소년과) ;
  • 윤소영 (관동대학교 의과대학 제일병원 소아청소년과) ;
  • 고선영 (관동대학교 의과대학 제일병원 소아청소년과) ;
  • 이연경 (관동대학교 의과대학 제일병원 소아청소년과) ;
  • 신손문 (관동대학교 의과대학 제일병원 소아청소년과)
  • Published : 2011.05.31
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Abstract

Purpose: To evaluate the effect of oral sildenafil therapy in neonates with persistent pulmonary hypertension of the newborn (PPHN) Methods: We conducted a retrospective review of 32 neonates ${\geq}$35 weeks' gestation and fraction of inspired oxygen ($FiO_2$) 1.0 with PPHN. The first dose (0.5 mg/kg) of oral sildenafil was started and 1 mg/kg was given every 6 hour thereafter. Mean airway pressure (MAP), $FiO_2$, oxygenation index (OI), mean arterial blood pressure (MBP) were documented before and 6, 12, 24, and 48 hours after sildenafil. For adverse effects, gastrointestinal symptoms, brain ultrasound, funduscopy and auditory brainstem response results were evaluated. Results: The underlying diseases of PPHN (n=32) were meconium aspiration syndrome (n=9), respiratory distress syndrome (n=8), pneumonia (n=3), and idiopathic (n=12). Thirty-one neonates survived; 3 neonates were transferred for inhaled nitric oxide (iNO) and all of them survived. In 28 infants, $FiO_2$ and OI improved significantly by 6 hours and MAP improved significantly by 48 hours after initiation of sildenafil. There were no clinically significant adverse effects of sildenafil. Conclusion: Sildenafil may be an effective and safe agent for near-term and term neonates with PPHN, providing significant improvement in oxygenation, and thus may be especially useful in the treatment of PPHN in hospitals without iNO.

목적: 최근 PPHN의 치료를 위해 iNO와 함께 많은 약물적 치료가 사용되고 있다. Sildenafil은 PDE5의 억제제로 선택적인 폐혈관 확장제로 알려져 있으며 iNO에 비하여 접근성이 뛰어나 iNO에 대안적인 약제로 연구되어 왔다. 저자들은 본원에서 sildenafil로 PPHN을 치료한 경험을 분석하였다. 방법: 심초음파를 통해 PPHN으로 진단된 재태 기간 35주 이상, FiO2 1.0을 필요로 하는 32명의 환아를 대상으로 하였으며 의무기록을 후향적으로 조사하였다. sildenafil은 0.5 mg/kg로 시작하여 6시간마다 1 mg/kg로 투약하였으며, 투약 전과 후 6, 12, 24, 48시간의 MAP, $FiO_2$, OI, MBP를 비교하였다. 부작용을 확인하기 위하여 환아들의 위장관 증상, 뇌초음파, 안저검사와 청성뇌간유발반응 검사의 결과를 조사하였다. 결과: 대상 환아 32명 중 태변 흡인 증후군 9명, 호흡곤란증후군 8명, 폐렴 3명이었으며, 12명은 특발성이었다. 이 중 31명이 생존하였으며 28명의 환아는 본원에서 sildenafil만으로 치료되었고 3명의 환아는 전원되어 iNO 치료 후 회복하였다. Sildenafil 단독으로 치료된 28명의 환아에서 $FiO_2$와 OI는 치료 6시간째부터 MAP는 48시간째부터 유의하게 감소하였다. 모든 환아에서 특별한 부작용은 관찰되지 않았다. 결론: Sildenafil은 35주 이상의 PPHN 환아에서 비교적 효과적이고 안전하게 시도해 볼 수 있는 대안 약제로서, 특히 iNO가 가능하지 않은 병원에서 유용할 것으로 생각된다.

Keywords

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