Closely monitor neonates receiving sildenafil for persistent pulmonary hypertension of the newborn (PPHN) for potential side effects. Regular assessments are paramount.
- Blood Pressure: Frequent blood pressure monitoring is crucial, aiming for at least every 4-6 hours initially, adjusting frequency based on stability. Hypotension is a significant concern. Oxygen Saturation: Continuous pulse oximetry is needed to track oxygenation. Unexpected drops warrant immediate attention. Respiratory Rate and Effort: Monitor breathing rate and work of breathing. Increased respiratory distress may indicate worsening PPHN or a sildenafil-related adverse effect. Cardiac Rhythm and Rate: EKG monitoring can detect arrhythmias. Regular assessment is advised, especially in the initial treatment phase. Apnea: Observe for apnea episodes. Increased apnea frequency can be a side effect. Respiratory support may be necessary.
Additional monitoring points include:
- Fluid Balance: Assess hydration status meticulously, paying close attention to fluid input and output. Sildenafil can influence fluid balance. Blood Gases: Periodic arterial blood gas analysis helps assess oxygenation and acid-base balance. Frequency depends on clinical stability. Renal Function: Monitor urine output and creatinine levels, particularly with prolonged treatment, as renal effects are possible. Gastrointestinal Symptoms: Observe for changes in feeding tolerance, vomiting, or diarrhea. These effects are less common but should be considered.
Documentation: Meticulous record-keeping of all observations and interventions is essential for effective management and potential future research. Immediate Response: Any significant changes warrant prompt clinical review and potentially dose adjustment or discontinuation of sildenafil.
Remember, close collaboration between neonatologists, respiratory therapists, and nurses is crucial for optimal management.
