Yes, Uncompromised Airways is a blog centered around the care provided to newborns in the neonatal ICU. Yes, Peewee Potions is the section that deals with interesting medications that we give to those newborns. And yes, believe it or not, sildenafil (most widely marketed under the trade name of Viagra) does have a place in the treatment of our NICU babies.
In 1998, sildenafil made headlines when Pfizer introduced it as the first FDA-approved oral treatment for erectile dysfunction. The drug had not always been envisioned as a prescription aphrodisiac, however. Initially, work at one of Pfizer's labs in England focused on its potential as an antihypertensive (blood pressure drug) and a treatment for angina pectoris.
Although sildenafil was found to be pretty ineffective for those two original purposes, the Sandwich, UK researchers did discover the drug's ability to render a man... tumescent. And apparently, someone kept thinking about the drug's cardiovascular properties. Now sildenafil is used in both adults and children for the treatment of pulmonary hypertension.
Persistent pulmonary hypertension of the newborn (PPHN) results from complications before, during or after delivery. Instead of the lung blood vessels relaxing in the moments to hours following delivery, they remain constricted as they were during pregnancy. This restricts the normal flow of blood to the lungs for oxygenation. Depending on the degree of constriction and the tension produced, the severity of PPHN varies greatly. Some patients have no symptoms, while others may die within days or survive with chronic oxygenation issues.
In babies, sildenafil was initially only employed at large academic medical centers in research protocols, often after the mainstay treatment (inhaled nitric oxide) had failed. Now it is making its way into non-academic NICU's. One advantage of the drug is that it can be given in both IV form (for very sick babies that aren't orally fed) and oral form (allowing the drug to be given even after the baby is discharged to home).
I don't think we've even seen the end of sildenafil's potential. There is talk of its usefulness in preventing plant wilting (absurdly phallic but true), treating altitude sickness and even enhancing sports performance. We should all stay tuned for the next chapter in the exciting life of a versatile drug.
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