الفهرس 
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Abstract
Persistent pulmonary hypertension of the newborn (PPHN) is a serious syndrome characterized by sustained elevation of pulmonary vascular resistance at birth. The incidence of PPHN is reported to reach 6.8 per 1000 live births. The clinical presentation of infants with PPHN includes labile hypoxemia and the findings of a gradient in oxygen saturations between preductal (right upper extremity) and post ductal values greater than 10%. However, these findings are not specific to PPHN, and it is important to differentiate cyanotic heart disease from PPHN, so the echocardiogram is an essential diagnostic tool for identifying and managing newborns with PPHN. Treatment of PPHN depends on the underlying disorder, aiming to decrease PVR and reduce the magnitude of the right-to-left shunt, mainly by administering pulmonary vasodilators. Depending on the severity, some infants may also require aggressive support of cardiac function, systemic blood pressure, and perfusion. Newborns who fail to respond to medical management, as determined by a failure to maintain improvements in oxygenation with good hemodynamic function, often require treatment with ECMO. PDE 5 is responsible for breaking down cGMP in the smooth muscle cell. Inhibiting PDE 5 extends the duration of activity of cGMP resulting in relaxation of the smooth vascular muscle. Thus, the inhibition of PDE 5 leads to vasodilation. Sildenafil and Tadalafil are PDE‐5 inhibitors approved for use in adults with pulmonary arterial hypertension. Tadalafil has larger selectivity for PDE5 and longer half‐life. The aim of this study was to compare the efficacy of tadalafil and sildenafil in controlling PPHN. The study was a prospective study and was conducted on 40 neonates with persistent pulmonary hypertension. Were admitted at neonatal intensive care unit at Tanta University Hospitals during the period of the study, were selected, enrolled in the study, and divided into two groups: group 1: Twenty case received tadalafil (Cialis 10mg) each tablet of the drug was crushed and ground to fine powder and added to 10 ml distilled water, with concentration 1mg/ml and given orally, 1mg/kg as a single dose / day for 48 hours. group 2: Twenty case received sildenafil (Silden 25mg) each tablet of the drug was crushed and ground to fine powder and added to 10 ml distilled water, with concentration 2.5mg/ml and given orally, 1 mg/kg three times/day for 48 hours. Inclusion criteria: Gestational age ≥ 37 weeks. PPHN was suspected by preductal and post ductal oxygen saturation difference ≥ 15 mmHg and persistent hypoxia PaO2 < 50 mmHg in spite of 100% oxygen supplementation. Echocardiography for the confirmation of the diagnosis of PPHN. Exclusion criteria: Gestational age < 37 weeks. Secondary pulmonary hypertension. Lung anomalies e.g., pulmonary hypoplasia. Cardiac anomalies Methodology: All cases were subjected to the following: Complete history taking: Pre-natal, natal, and post-natal. Routine laboratory investigations: Complete blood picture, CRP, liver function tests, renal function tests, random blood sugar, serum electrolytes and blood gases. Chest-X-Ray: for exclusion of any lung diseases. Echocardiography: For initial diagnosis and assessing the severity of persistent pulmonary hypertension. Echocardiographic examination done at time of enrollment and 48 hours after starting treatment, done by single operator who was blinded to the study. Follow Up of the two groups: After 48 hours of treatment two groups were assessed to evaluate the drug efficacy. The study revealed that: There was no statistically significant difference between the two studied groups as regards gestational age, sex, birth length, birth weight, birth head circumference, mode of delivery, maternal age and APGAR score in 1st and 5th minute. There was no statistically significant difference between the 2 studied groups as regards maternal diseases during the pregnancy. There was no statistically significant difference between the 2 studied groups as regards respiratory support and duration of hospitalization. There was no statistically significant difference between the 2 studied groups as regards hemodynamic support. There was no statistically significant difference between the 2 studied groups as regards mortality rate. There was no statistically significant difference between the 2 studied groups as regards initial FIO2. There was no statistically significant difference between the 2 studied groups as regards initial capillary blood gases (CBG) There was statistically significant difference in the 2 studied groups before and after treatment as regards SpO2, but as regards comparing the studied groups there was no statistically significant difference between the 2 groups before treatment (p=0.841), after treatment (p =0.925) and mean of change (p=0.478). There was no statistically significant difference between the 2 studied groups as regards initial Echo findings (RVEDD, TAPSE, PDA direction and LV FS). There was statistically significant difference in the 2 studied groups before and after treatment as regards ESPAP, but as regards comparing the studied groups there was no statistically significant difference between the 2 groups before treatment (p=0.608), after treatment (p=0.942) and mean of change (p=0.327). There was no statistically significant difference between the 2 studied groups as regards drug efficacy, in group I the drug was effective in 17 cases (85%), in group II the drug was effective in 16 cases (80%), there was no statistically significant difference between the 2 groups (p=1.000).