A retrospective review of infants receiving sildenafil

Aliva De, Payal Shah, Jacqueline Szmuszkovicz, Shazia Bhombal, Stanley Azen, Roberta M. Kato

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

OBJECTIVE The purpose of the study was to assess mortality in an infant population receiving sildenafil. METHODS A retrospective review of hospitalized infants at Children’s Hospital Los Angeles who received sildenafil between 2008 and 2012 was conducted. Patient characteristics, comorbidities, and treatment characteristics were analyzed. Primary outcome was mortality at discharge. Sildenafil dosage ranges were based on the Sildenafil in Treatment-Naïve Children, Aged 1–17 Years, With Pulmonary Arterial Hypertension trial and were categorized as small (<1.5 mg/kg/day), medium (1.5–3.75 mg/kg/day), large (3.76–7.5 mg/kg/ day), and very large (>7.5 mg/kg/day). RESULTS A total of 147 infants were studied. A total of 82% of patients had severe pulmonary hypertension. Our data revealed 29% mortality at discharge. Mortality increased with increasing sildenafil dosage: 14% (small), 19% (medium), 49% (large), and 90% (very large). On multivariate analysis of sildenafil dosage, other pulmonary hypertension therapies, presence of persistent cardiac shunts, and duration of sildenafil, odds of dying were significantly higher with combined high and very high sildenafil dosage groups compared with combined low and medium dosage groups (OR, 13.2; CI, 4.4–39.5; p < 0.0001). CONCLUSION Sildenafil was given to critically ill infants with multiple risk factors for mortality. Although higher doses cannot be causally related to mortality, there appears to be no added benefit by escalating the sildenafil dose.

Original languageEnglish (US)
Pages (from-to)100-105
Number of pages6
JournalJournal of Pediatric Pharmacology and Therapeutics
Volume23
Issue number2
DOIs
StatePublished - Mar 1 2018
Externally publishedYes

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Pulmonary Hypertension
Mortality
Sildenafil Citrate
Los Angeles
Infant Mortality
Critical Illness
Comorbidity
Therapeutics
Multivariate Analysis
Population

Keywords

  • Infants
  • Mortality
  • Pediatric pulmonary hypertension
  • Sildenafil

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pharmacology (medical)

Cite this

A retrospective review of infants receiving sildenafil. / De, Aliva; Shah, Payal; Szmuszkovicz, Jacqueline; Bhombal, Shazia; Azen, Stanley; Kato, Roberta M.

In: Journal of Pediatric Pharmacology and Therapeutics, Vol. 23, No. 2, 01.03.2018, p. 100-105.

Research output: Contribution to journalReview article

De, Aliva ; Shah, Payal ; Szmuszkovicz, Jacqueline ; Bhombal, Shazia ; Azen, Stanley ; Kato, Roberta M. / A retrospective review of infants receiving sildenafil. In: Journal of Pediatric Pharmacology and Therapeutics. 2018 ; Vol. 23, No. 2. pp. 100-105.
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N2 - OBJECTIVE The purpose of the study was to assess mortality in an infant population receiving sildenafil. METHODS A retrospective review of hospitalized infants at Children’s Hospital Los Angeles who received sildenafil between 2008 and 2012 was conducted. Patient characteristics, comorbidities, and treatment characteristics were analyzed. Primary outcome was mortality at discharge. Sildenafil dosage ranges were based on the Sildenafil in Treatment-Naïve Children, Aged 1–17 Years, With Pulmonary Arterial Hypertension trial and were categorized as small (<1.5 mg/kg/day), medium (1.5–3.75 mg/kg/day), large (3.76–7.5 mg/kg/ day), and very large (>7.5 mg/kg/day). RESULTS A total of 147 infants were studied. A total of 82% of patients had severe pulmonary hypertension. Our data revealed 29% mortality at discharge. Mortality increased with increasing sildenafil dosage: 14% (small), 19% (medium), 49% (large), and 90% (very large). On multivariate analysis of sildenafil dosage, other pulmonary hypertension therapies, presence of persistent cardiac shunts, and duration of sildenafil, odds of dying were significantly higher with combined high and very high sildenafil dosage groups compared with combined low and medium dosage groups (OR, 13.2; CI, 4.4–39.5; p < 0.0001). CONCLUSION Sildenafil was given to critically ill infants with multiple risk factors for mortality. Although higher doses cannot be causally related to mortality, there appears to be no added benefit by escalating the sildenafil dose.

AB - OBJECTIVE The purpose of the study was to assess mortality in an infant population receiving sildenafil. METHODS A retrospective review of hospitalized infants at Children’s Hospital Los Angeles who received sildenafil between 2008 and 2012 was conducted. Patient characteristics, comorbidities, and treatment characteristics were analyzed. Primary outcome was mortality at discharge. Sildenafil dosage ranges were based on the Sildenafil in Treatment-Naïve Children, Aged 1–17 Years, With Pulmonary Arterial Hypertension trial and were categorized as small (<1.5 mg/kg/day), medium (1.5–3.75 mg/kg/day), large (3.76–7.5 mg/kg/ day), and very large (>7.5 mg/kg/day). RESULTS A total of 147 infants were studied. A total of 82% of patients had severe pulmonary hypertension. Our data revealed 29% mortality at discharge. Mortality increased with increasing sildenafil dosage: 14% (small), 19% (medium), 49% (large), and 90% (very large). On multivariate analysis of sildenafil dosage, other pulmonary hypertension therapies, presence of persistent cardiac shunts, and duration of sildenafil, odds of dying were significantly higher with combined high and very high sildenafil dosage groups compared with combined low and medium dosage groups (OR, 13.2; CI, 4.4–39.5; p < 0.0001). CONCLUSION Sildenafil was given to critically ill infants with multiple risk factors for mortality. Although higher doses cannot be causally related to mortality, there appears to be no added benefit by escalating the sildenafil dose.

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