Preterm infants at risk of BPD

Konig et al⁶ performed an RCT in preterm infants, < 28 weeks gestational age, if they were mechanically ventilated on day 7 of life. Infants were randomised to a 4-week course of either oral sildenafil (3 mg/kg/day) or placebo solution. Twenty infants were randomised, 10 received sildenafil and 10 received placebo. Sildenafil did not reduce length of invasive (median 688 versus 227 h) or non-invasive ventilation (median 1609 versus 1416 h). More infants in the sildenafil group required postnatal steroid treatment. One infant developed hypotension following sildenafil administration and was excluded after three doses. Conclusion: Sildenafil as an early treatment for preterm infants at risk of BPD is not beneficial.

Namachivayam et al⁸ performed an RCT in 30 ventilated infants and children from varying respiratory conditions including BPD (average age 0.4 y) and receiving 10 ppm iNO. They were randomised to either 0.4 mg/kg as a single oral dose of sildenafil or placebo 1 h before discontinuing iNO. Rebound occurred in 10/14 of the placebo group and 0 out of 15 in the sildenafil group. Four placebo patients couldn’t be weaned off iNO, whereas all in the sildenafil group were successfully weaned (p = 0.042). A single oral dose of sildenafil may be considered for this particular scenario (LOE II, GOR C).