Combined oral Sildenafil and Bosentan in an ex preterm infant with bronchopulmonary dysplasia, sepsis and severe pulmonary arterial hypertension refractory to inhaled nitric oxide

Objective: To describe the combined use of novel vasodilatator agents (i.e., Sildenafil and Bosentan) to increase the overall efficacy of therapeutic interventions for pulmonary arterial hypertension. Methods: We report a case of a 5-month-old preterm infant with bronchopulmonary dysplasia, who developed ARDS related to sepsis and pneumonia from Stenotrophomonas Maltophilia and severe pulmonary arterial hypertension refractory to inhaled nitric oxide and maximal ventilatory support. She was treated with either antibiotic, hemodinamic support and a combination of oral Sildenafil and Bosentan therapy. Results: Forty-eight hours after starting Sildenafil plus Bosentan, there was an improvement in her clinical condition, with a reduction in the oxygen requirement and a significant improvement of the laboratory tests. An echocardiogram showed a substantial reduction in pulmonary hypertension. No complications or adverse effects related to long term Sildenafil or Bosentan therapy were noted. Conclusion: This case illustrates the safety and efficacy of a combination treatment with oral Sildenafil and Bosentan in a infants with bronchopulmonary dysplasia and severe pulmonary hypertension secondary to ARDS refractory to inhaled nitric oxide. To describe the combined use of novel vasodilatator agents (i.e., Sildenafil and Bosentan) to increase the overall efficacy of therapeutic interventions for pulmonary arterial hypertension. Methods: We report a case of a 5-month-old preterm infant with bronchopulmonary dysplasia, who developed ARDS related to sepsis and pneumonia from Stenotrophomonas Maltophilia and severe pulmonary arterial hypertension refractory to inhaled nitric oxide and maximal ventilatory support. She was treated with either antibiotic, hemodinamic support and a combination of oral Sildenafil and Bosentan therapy. Results: Forty-eight hours after starting Sildenafil plus Bosentan, there was an improvement in her clinical condition, with a reduction in the oxygen requirement and a significant improvement of the laboratory tests. An echocardiogram showed a substantial reduction in pulmonary hypertension. No complications or adverse effects related to long term Sildenafil or Bosentan therapy were noted. Conclusion: This case illustrates the safety and efficacy of a combination treatment with oral Sildenafil and Bosentan in a infants with bronchopulmonary dysplasia and severe pulmonary hypertension secondary to ARDS refractory to inhaled nitric oxide.