1.Department of Neonatology,the 5th Medical Center of Chinese PLA General Hospital,Beijing 100071, China; 2.Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China; 3.First School of Clinical Medical Sciences,Lanzhou University, Lanzhou 730000, China; 4.Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, China
Abstract：Objective To evaluate the efficacy and safety of sildenafil in the treatment of persistent pulmonary hypertension in newborns, and to provide evidence-based reference for clinical treatment. Methods Databases including PubMed, the Cochrane Library, Ovid-EMbase, CJFD, Wanfang Data, CBM and VIP were searched to collect RCTs about PPHN treated with sildenafil in newborns. Meta-analysis was performed by using RevMan 5.3 software after data extraction and quality evaluation according to the clinical inclusion and exclusion criteria. Results A total of 9 RCTs were included. The results of meta-analysis showed that, compared with basic therapy, sildenafil could significantly reduce the mortality[RR=0.16,95％CI(0.06,0.41),P＜0.01]and pulmonary arterial pressure[MD=13.69,95％CI(3.98,23.40), P＜0.01],increase oxygen partial pressure [MD=6.51,95％CI(5.13,7.89), P＜0.01],and reduce carbon dioxide partial pressure[MD=16.04,95％CI(11.33,20.74), P＜0.01].The difference was statistically significant,but there was no statistically significant difference in the increase of oxygen saturation[MD=14.34,95％CI(-3.72,32.40),P＞0.01] or in the decrease of oxygenation indexes[MD=21.43,95％CI(-3.98,46.84),P=0.01]. Conclusions Current evidence suggests that sildenafil can improve the mortality and pulmonary arterial pressure during the treatment of PPHN, and is effective for increasing oxygen partial pressure and decreasing carbon dioxide partial pressure.Because of the limited amount of inclusion and follow-up time of research, the mechanism by which the length of hospital stay and the duaration of mechanical ventilation are shortened is not clear. Moreover, long-term safety evaluation results are lacking.
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