Efficacy and safety of different doses of sildenafil combined with inhaled nitric oxide in the treatment of neonatal pulmonary hypertension
GUO Jing
ZHOU Xuping
XIN Jun
Abstract：Objective To explore the efficacy and safety of different doses of sildenafil combined with inhaled nitric oxide(iNO)in the treatment of persistent pulmonary hypertension of the newborn(PPHN).Methods A total of 68 PPHN infants admitted to Zhumadian Central Hospital from March 2021 to March 2025 were selected and divided into the low-dose group(n=22),the medium-dose group(n=24),and the high-dose group(n=22)using a randomized block design.All three groups received silde-nafil combined with iNO therapy,with sildenafil doses of 1.0 mg/kg,1.5 mg/kg,and 2.0 mg/kg in the low-dose group,medium-dose group,and high-dose group.The clinical efficacy,blood gas analysis parameters(arterial oxygen partial pressure(PaO2),arterial car-bon dioxide partial pressure(PaCO2),oxygen saturation(SaO2)),pulmonary artery parameters(pulmonary artery systolic pressure(PAP),pulmonary artery diameter),and incidence of adverse reactions were compared among the three groups.Results The total effective rate were 95.45％(21/22)in the high-dose group,79.17％(19/24)in the medium-dose group,and 63.64％(14/22)in the low-dose group.The difference between the high-dose group and low-dose groups was statistically significant(x2=6.844,P＜0.05),while no statistically significant differences were observed between the high-dose group and medium-dose group or between the medium-dose group and low-dose group(x2=2.685,1.366,both P＞0.05).After treatment,the PaO2 and SaO2 levels increased in all three groups,with the high-dose group((85.32±4.74)mmHg(1 mmHg=0.133 kPa),(97.85±1.35)％)being significantly high-er than those in the low-dose group((78.23±4.86)mmHg,(94.53±1.84)％)(t=4.899,6.824,both P＜0.05)and the medium-dose group((80.51±5.12)mmHg,(95.32±1.56)％)(t=3.297,5.857,both P＜0.05).Additionally,the PaCO2 levels decreased in all three groups after treatment,with the high-dose group((35.51±2.67)mmHg)being significantly lower than the low-dose group((38.25±3.14)mmHg)(t=3.118,P＜0.05).After treatment,the PAP and pulmonary artery diameter decreased in all three groups,and the high-dose group((26.14±2.87)mmHg,(7.84±0.66)mm)and the medium-dose group((27.34±3.28)mmHg,(8.24±0.74)mm)showed lower values than the low-dose group((32.55±3.57)mmHg,(9.56±0.87)mm)(t=6.564,5.159,7.388,5.558,all P＜0.05).No statistically significant difference was observed in the incidence of adverse reactions among the three groups(low-dose group:9.09％(2/22),medium-dose group:16.67％(4/24),high-dose group:36.36％(8/22))(x2=5.353,P＞0.05).Conclusion Sildenafil combined with iNO is effective in improving blood gas parameters and pulmonary artery metrics in neonates with PPHN,with an acceptable safety profile.The efficacy of sildenafil at 2.0 mg/kg is superior to that at 1.0 mg/kg and comparable to that at 1.5 mg/kg.However,the incidence of adverse reactions is higher at 2.0 mg/kg than at 1.0 mg/kg and 1.5 mg/kg.
Keywords：sildenafilinhaled nitric oxidepersistent pulmonary hypertension of the newbornefficacysafety
Publication Date：2026-01-25
Online Publishing Date：2026-03-03(First online date of this platform, not the publication date of the document)
Pages：5( 107-111 )