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Viagra in neonates. Nd several "alternative" therapies such as high-frequency ventilation (HFV), surfactant, and inhaled NO (iNO) used in a rescue mode have produced varying degrees of success to decrease ECMO use.16 With as many as 30% of cases failing to respond, iNO has not proven to be the single magic bullet. The use of iNO as a treatment option for neonates with refractory hypoxemia has been reviewed recently in detail by Kinsella and Abhman.17 In addition to these therapies, inhaled prostacyclin has been reported effective also.18 However, ECMO and iNO are expensive16 and unavailable in many regions of the world in which mortality resulting from severe PPHN is much higher than in industrialized nations. ECMO is not free of serious adverse effects.16 Furthermore, in industrialized nations, some of the PPHN survivors have high morbidity in the forms of neurodevelopmental and audiological impairment, cognitive delays, hearing loss, and a high rate of rehospitalization.14,15 Finding an effective and selective pulmonary vasodilator with little or no adverse effects for the treatment of PPHN has been elusive over the past 20 years. Oral sildenafil, a potential such therapy, has not been systematically evaluated in newborns with PPHN. However, reviews have been published recently both for adults and neonates.15,19& 150;21 In addition, published uncontrolled case reports,10& 150;13 a presented abstract in the Pediatric Society annual meeting,22 and verbal communication demonstrate that oral sildenafil is being used off-label without any protocol or clinical guideline. According to these reviewe
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Peer-reviewed journal.Note that sildenafil is not FDA approved for use in newborns. More than 90% of the half-million babies afflicted with the condition are in Third-World countries, and 40% to 80% of them die because there is no treatment available Dr. Soliz said. In the U.S. and other developed countries, inhaled nitric oxide effectively treats infants with persistent pulmonary hypertension. But the gas is either unavailable or prohibitively expensive at most treatment centers in developing countries. On the other hand, sildenafil -- a type V phosphodiesterase inhibitor primarily used for erectile dysfunction in adults -- is widely available for $5 to $10 per adult dose in developing areas, Dr. Soliz said. The drug, originally developed to treat hypertension and angina, works in persistent pulmonary hypertension patients by selectively reducing pulmonary vascular resistance. It is not FDA approved for newborns. Although smaller studies have shown the drug's utility in treating persistent pulmonary hypertension, the current study is the largest to date. For the study, Dr. Soliz and colleagues randomized 49 neonates at three centers in Mexico and El Salvador to either sildenafil or placebo. After crushing and diluting a 2 mg kg dose of the normally adults-only pill, doctors administered the medication to the test group by orogastric tube every six hours from birth to three days. Within the first hour, changes in the oxygenation index in the sildenafil group were significant through 72 hours (P Add Your Knowledge™ Contribute your own thoughts, experience, questions, a 