الفهرس 
Respiratory DistressOnly 14 pages are availabe for public view
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Abstract
Pulmonary hypertension is a common problem in the neonatal intensive care unit and is associated with significant morbidity and mortality. The management of pulmonary hypertension is multi-faceted Common therapies including the stabilization of the newborn, the use of inhaled nitric oxide; high frequency ventilation, surfactant, and extracorporeal life support are included. Promising new treatment approaches like phosphodiesterase inhibition (sildenafil). A newer form of ventilation called high frequency oscillatory ventilation has been shown to result in less lung injury. Current evidence suggests High frequency ventilation may be superior to other respiratory support modes in eliminating carbon dioxide. High Frequency ventilator has given promising results in all age groups including neonates. Compared with conventional mechanical ventilator, high frequency mechanical ventilator performs better in improving the pulmonary oxygenation function of neonates with pneumothorax and can shorten both mechanical ventilation time and gas absorption time without increasing the incidence of adverse effects. HFOV is a safe and effective rescue therapy for neonates with pulmonary hypertension who fail conventional ventilation. Sildenafil has been used in pulmonary hypertension since 1999. Recent studies have proposed the use of sildenafil in refractory forms of neonatal pulmonary hypertension. In cases where treatment with inhaled iloprost, inhaled nitric oxide (iNO) and extra corporeal membrane oxygenation is not possible, oral sildenafil can be an alternative therapy option in the treatment of pulmonary hypertension. Sildenafil mediated inhibition of phosphodiesterase type-5 leads to an increase in intracellular cyclic guanosine monophosphate, which results in pulmonary vasodilation. The Aim of our study was to compare between the efficacy of high frequency ventilation and sildenafil in management of pulmonary hypertension in neonates. Our study was carried out on 90 neonates who presented with pulmonary hypertension, among them 6 neonates with CDH, 13 neonates with pneumonia and 39 neonates with PDA. The 90 neonates were divided into three groups: group A: This group included 30 neonates with pulmonary hypertension (7 females and 23 males) who received oral sildenafil and conventional mechanical ventilation. group B: This group included 30 neonates with pulmonary hypertension (9 females and 21 males) who were on high frequency oscillatory ventilation. group C: This group included 30 neonates with pulmonary hypertension (10 females and 20 males) who received both oral sildenafil and high frequency oscillatory ventilation. All neonates were subjected to full history taking including gestational age, sex, maternal history, clinical examination with special emphasis on heart rate, respiratory rate, mean blood pressure, pulmonary blood pressure, CBC, CRP and ABG. Echocardiography was performed to every neonate: • Immediately after admission. • After 48 hours of starting treatment. • After 5 days of starting treatment. The result of the current study demonstrated that: There was no statically significant difference between neonates in the three groups as regard age, sex, weight, height, CBC, CRP, PH, PCO2, HCO3, right ventricular diameter and pulmonary pressure at time of admission. There was statically high significant increase in mean value of PaO2 in cases received both high frequency ventilation and sildenafil than cases received both sildenafil and conventional mechanical ventilation and cases who received high frequency ventilation alone with p-value <0.001. There was statically high significant decrease in mean value of Fio2 in cases received both high frequency ventilation and sildenafil than cases received both sildenafil and conventional mechanical ventilation and cases who received high frequency ventilation alone with p-value <0.001. There was statically high significant decrease in mean value of P mean in cases received both high frequency ventilation and sildenafil than cases received both sildenafil and conventional mechanical ventilation and cases who received high frequency ventilation alone with p-value <0.001. There was statically high significant decrease in mean value of oxygenation index in cases received both high frequency ventilation and sildenafil than cases received both sildenafil and conventional mechanical ventilation and cases who received high frequency ventilation alone with p-value <0.001. There was statically high significant decrease in mean value of Aa gradient in cases received both high frequency ventilation and sildenafil than cases received both sildenafil and conventional mechanical ventilation and cases who received high frequency ventilation alone with p-value <0.001. There was statically high significant decrease in mean value of pulmonary blood pressure after 48 hours in cases received both high frequency ventilation and sildenafil than cases received both sildenafil and conventional mechanical ventilation and cases who received high frequency ventilation alone with p-value <0.001. There was statically high significant decrease in mean value of pulmonary blood pressure after 5 days in cases received both high frequency ventilation and sildenafil than cases received both sildenafil and conventional mechanical ventilation and cases who received high frequency ventilation alone with p-value <0.001.