Author: Murphy A, Turnbull C, Nesbitt V, Guratski V, Kamalanathan A
Abstract: INTRODUCTION: Sildenafil is increasingly used to treat PPHN secondary to chronic lung disease in neonates. Severity of PPHN has been linked to increased mortality at two years.(1) There is no national guideline advising clinicians on dosage or weaning schedules for use of Sildenafil in neonates. METHODS: A telephone survey of tertiary level neonatal units in England and Wales (n = 48) was conducted in December 2013 and January 2014. Neonatal consultants were contacted to ensure robust data. In the event a consultant was not available, staffs employed by the unit for at least 24 months (Specialist registrar, Advanced Neonatal Nurse Practitioner (ANNP) or nursing sister) were surveyed. RESULTS: The response rate was 90% (n = 43/48). Sildenafil was used frequently (>5 patients per year) in 12% (n = 5), infrequently, (1-5 patients per year) in 23% (n = 10) and rarely (<1 per year) in 51% (n = 22). Majority of units had used Sildenafil within the last 6 months 49% (n = 21). 60% (n = 26) used Sildenafil only after discussion with Cardiologists, 35% (n = 15) commenced Sildenafil after discussion with neonatal colleagues. No unit had fixed indications for commencement of Sildenafil. Amongst those with a guideline (n = 6); the initial dose varied between 250-300 mcg/kg commenced between 4 and 12 hourly. Guidelines on two units were unclear on rate of increase of Sildenafil. No guideline stipulated weaning/stopping practice. CONCLUSION: Sildenafil is infrequently used in NICU, however only 6 units did not use Sildenafil in the past 24 months. Variability in practice amongst units mirrors the need for a national consensus guideline.
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