EBNEO commentary: Oral versus intravenous sildenafil for pulmonary hypertension in neonates

Persistent pulmonary hypertension (PPHN) involves persistent pulmonary vascular resistance, which occurs in approximately 2 in every 1000 live infants. This is associated with sequelae, including chronic lung disease, neurodevelopmental complications, and death. The current well-understood management of PPHN includes inhaled nitric oxide (iNO), which is used as the first-line treatment of PPHN in higher-resourced countries. However, less-resourced countries have limited availability to iNO. There is some literature on other treatments, including sildenafil; however as recommended in the 2017 Cochrane review which evaluated five randomised clinical trials and several case reports that sildenafil has the potential to increase survival in neonates with PPHN, particularly in settings where iNO is not available.