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Sildenafil treatment differs by age, BPD severity in pediatric patients
Factors such as gestational age and bronchopulmonary dysplasia severity influenced whether sildenafil was used in pediatric hospitals across the United States, according to results from a retrospective study.
“Early clinical experience indicates that sildenafil treatment may be efficacious for infants with [bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH)], with evidence suggesting that sildenafil normalizes lung development and may improve outcomes,” Carl H. Backes, MD, from The Heart Center at Nationwide Children’s Hospital, and colleagues wrote. “However, practice patterns for sildenafil treatment in infants with BPD-PH have not been fully reported; these patterns include variables associated with exposure, timing of initiation, length of treatment, and interhospital variation in use.”
Carl H. Backes
Backes and colleagues identified 3,720 infants at 36 U.S. hospitals with BPD from 2006 through 2013. Of these patients, 16% also had coexisting PH, of which 104 infants within this group received sildenafil.
The researchers found gestational age influenced the likelihood of sildenafil administration, with infants born at 25 to 26 weeks’ gestation having greater odds of treatment with sildenafil (OR = 2.26; 95% CI, 1.2-4.24), and infants born before 24 weeks’ gestation showing an OR of 3.21 (95% CI, 1.66-6.21) compared with infants born at 27 weeks or 28 weeks’ gestational age, according to the study.
Moderate BPD (adjusted OR = 3.03; 95% CI, 1.03-8.93) and severe BPD (aOR = 7.56; 95% CI, 2.5-22.88) also were associated with an increased likelihood of sildenafil treatment. Further, infants considered small for neonates, based on their gestational age, also were more likely to be treated with sildenafil (OR = 2.32; 95% CI, 1.21-4.46).
“Although sildenafil was not administered to the majority of infants with BPD-PH during their hospitalization, the likelihood of sildenafil exposure was greatest among the most premature infants with severe forms of BPD,” Backes and colleagues wrote. “Patient-centered trials of infants with BPD-PH are needed to develop evidence-based practices.” – by Jeff Craven
Disclosure: The researchers report no relevant financial disclosures.
