Tadalafil in Neonates and Infants With Pulmonary Hypertension Secondary to Bronchopulmonary Dysplasia

Abstract

OBJECTIVES The primary outcome of this study was to describe the dosing regimen of tadalafil in neonates and infants diagnosed with pulmonary hypertension (PH) secondary to bronchopulmonary dysplasia (BPD). Secondary outcomes included tolerability, efficacy, adverse events, discontinuation of therapy, and changes in echocardiography. METHODS This was a single-center, retrospective review of neonates and infants <1 year of age at initiation of tadalafil for PH secondary to BPD from January 2010 to November 2021. Data collected from the electronic medical record included patient demographics, tadalafil dosing, oxygen support, mechanical ventilation, concomitant PH medications, adverse events, and echocardiography information. RESULTS Forty-two patients—4 neonates and 38 infants—met the inclusion criteria. The postnatal and postmenstrual age (median, IQR) at diagnosis were 121 (35.5–153.5) days and 42.6 (40.6–47.6) weeks, respectively. The initial and highest tadalafil doses (median, range) were 1 (0.25–2) and 1 (0.5–2) mg/kg/day. Only 1 patient experienced pulmonary overcirculation and required tadalafil to be discontinued. Over half (57.1%) of the patients in this study discontinued tadalafil therapy owing to improvements in pulmonary artery pressures. CONCLUSIONS Tadalafil 1 mg/kg/day was the most commonly used dose regimen in neonates and infants. Tadalafil at this dose of 1 mg/kg/day appears well tolerated in neonates and infants with PH secondary to BPD and correlates with improvements in pulmonary artery pressures. Further studies evaluating tadalafil in comparison to other phosphodiesterase-5 inhibitors in neonates with PH secondary to BPD are warranted. ABBREVIATIONS BPD, bronchopulmonary dysplasia; iNO, inhaled nitric oxide; PDE5, phosphodiesterase-5; PH, pulmonary hypertension; RVSP; right ventricular systolic pressure.