Paradigmas actuales de la hipertensión pulmonar persistente neonatal. Revisión Sistemática

Abstract

Persistent pulmonary hypertension of the newborn (PPHN) is a heterogeneous condition associated with significant mortality; it is delimited by a defect in the fetal-neonatal circulation causing cyanosis, hypoxemia, and respiratory acidosis; pharmacological management seeks to reduce pulmonary vascular resistance. Therefore, the first line of treatment is Nitric Oxide, Sildenafil; Bosentan, Treprostinil, Iloprost, Adenosine, and Hydrocortisone are highlighted as second and third-line treatments for refractory PPHN. However, the use of these oral agents is limited due to their high cost, necessitating the exploration of alternative treatment modalities for PPHN. The use of these oral agents is limited by the lack of acquisition by the health system due to their high cost, making it unavoidable to know the alternative treatment modalities in PPHN. Objective: To analyze the current pharmacological paradigms associated with PPHN through a systematic review. Methodology: This is a descriptive, qualitative, inductive research linked to the PRISMA statement. Twenty-five full-text articles were evaluated from various scientific databases such as Cochrane, Scopus, PubMed, Proquest, Taylor & Francis, UpToDate, and Web of Science. Results: The safety and efficacy of pharmacological therapies are based on their mechanisms of action (cGMP, PDE type 5 and 3, PC, and ET). Treprostinil, which reduces the risk of treatment discontinuation, has shown effectiveness in combination therapy with Nitric Oxide. Bosentan increases the rate of clinical improvement but poses a risk of liver toxicity; however, further evidence is needed for these medications in neonates. Keywords: Sildenafil, Nitric Oxide, Treprostinil, Bosentan, Selexipag.