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Sildenafil Stops Rebound Hypertension in Children

One dose prevents pulmonary hypertension after weaning from inhaled nitric oxide

WEDNESDAY, Nov. 1 (HealthDay News) -- Single-dose, prophylactic sildenafil prevents rebound pulmonary arterial hypertension in children after weaning from inhaled nitric oxide, and decreases mechanical ventilation duration, according to research published in the November issue of the American Journal of Respiratory and Critical Care Medicine.

Poongundran Namachivayam, M.R.C.P.C.H., of The Royal Children's Hospital in Melbourne, Australia, and colleagues examined sildenafil in preventing rebound (defined as a 20 percent or more pulmonary arterial pressure rise or failure to stop nitric oxide). The researchers evaluated data from 29 ventilated infants and children randomized to 0.4 mg/kg of sildenafil or placebo.

None of 15 treated patients had rebound, while 10 of 14 placebo patients did. Pressure rose 25 percent in placebo and 1 percent in treated patients. All treated patients were weaned from nitric oxide, but severe cardiovascular instability prevented weaning of four placebo patients. Placebo patients were ventilated for a mean of 98 hours while treated patients were ventilated for 28.2 hours.

"A single dose of enteral sildenafil effectively prevented the development of rebound pulmonary hypertension in infants and children after withdrawal of inhaled nitric oxide, and reduced the subsequent duration of mechanical ventilation. The prophylactic administration of sildenafil should be considered when weaning infants and children from inhaled nitric oxide," the authors conclude.

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