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Sildenafil for pulmonary hypertension in neonates: An updated systematic review and meta‐analysis
Author(s) -
He Zonglin,
Zhu Sui,
Zhou Kai,
Jin Ya,
He Longkai,
Xu Weipeng,
Lao CheokUn,
Liu Guosheng,
Han Shasha
Publication year - 2021
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/ppul.25444
Subject(s) - medicine , sildenafil , meta analysis , cochrane library , pulmonary hypertension , publication bias , placebo , bronchopulmonary dysplasia , randomized controlled trial , adverse effect , anesthesia , confidence interval , cardiology , pregnancy , gestational age , alternative medicine , pathology , biology , genetics
Objectives To provide an updated review and meta‐analysis on the efficacy and safety of sildenafil for treating persistent pulmonary hypertension in neonates (PPHN). Methods PubMed/Medline, SCOPUS, Cochrane Central Register of Controlled Trials, and Web of Science were searched from the inception of publication to January 2021. The principal outcomes include oxygenation parameters, hemodynamic metrics and echocardiographic measurements, as well as adverse outcomes. Results A total of eight studies were included with 216 term and premature neonates with PPHN. Compelling evidence showed the use of sildenafil could improve the prognosis of PPHN neonates, compared with baseline or placebo in neonates with PPHN, and a time‐dependent pattern of the improvements can be observed. After 24 h of treatment, the Oxygenation index suggested a steady decrease ( SD : −1.80, 95% confidence interval [CI]: −2.92, −0.67) and sildenafil exerted peak effects after 72 h of treatment ( SD : −4.02, 95% CI: −5.45, −2.59). No clinically significant side effects were identified. Egger's test and funnel plots of the major outcomes were performed, and the publication bias was not significant. Conclusion Improvements were shown in oxygenation index, pulmonary arterial pressure, and adverse outcomes after using sildenafil for PPHN in neonates. However, future research with robust longitudinal or randomized controlled design is still needed.