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Advantages of using sildenafil citrate or Viagra
What followed was a nail-biting battle for life through the darkest hours of the night. The central figure was of course the tiny girl, but waging the war were a team of doctors led by Dr P K Rajiv, Head of the Department of New-Born Intensive Care. The infant was put on conventional ventilation, but there was no significant improvement in the level of oxygen in her blood. High-frequency ventilation was then resorted to, but even this failed to have the desired effect. Parameters indicated very severe respiratory failure. Dr Rajiv introduced nitric oxide through the ventilator, at the standard dose of 40 parts per million (ppm). No response. It was then that he took a bold decision to double the dose. The doctor noted with relief the slight improvement in oxygenation levels in the blood. But the danger was far from over. Some push was necessary, something to pull the little girl back from the brink of death into the land of the living. Dr Rajiv chose an as yet unorthodox catalyst to do the trick - sildenafil citrate - better known to the man-on-the-street as Viagra, the wonder drug for impotency. Around 3 am, oxygen levels in the blood finally showed an improvement to levels compatible with life, and the doctors' hearts were filled with hope. Subsequently in a very complicated maneuver with the ventilator, the baby's oxygen requirement was reduced very gradually. This was a critical step since the whole balance of the good oxygenation obtained so far could flip-flop, making the baby critically ill again. But, the effort succeeded, and, within the next 48 hours the baby was gradually weaned off the high levels of oxygen and totally removed from the ventilator after five days of treatment. This use of sildenafil citrate for therapy of life-threatening pulmonary diseases in newborns was unique, possibly in India and certainly in Kerala. The young doctor, who graduated from the Calicut Medical College in 1982, has come a long way. He did his DCH SSG at the Baroda Medical College, and took his MD from the KMC, Mangalore. Subsequently, he undertook a Fellowship in Neonatology at the Sydney University between 1989 and 1991, and a Fellowship in High Frequency Ventilation in USA in 1997. Dr Rajiv joined the Consultant Division of the Child's Trust Hospital, Chennai, in 1991. He also served as Medical Director and Head of New Born Intensive Care, PVS Memorial Hospital, Kochi, Kerala, (1992 - 1999) and Head of New Born Intensive Care Apollo Mallya Hospital Bangalore (1999 - 2002) Dr Rajiv joined the Amrita Institute earlier this year. Dr Rajiv was the first to introduce advanced neonatal care to Kerala in 1993 and the concept of corporate super-specialty hospitals in this region. As head of newborn intensive care in PVS Memorial Hospital he saved a 500gm baby born after just 22-1/2 weeks of gestation - a feat unique in India. Subsequently he introduced high frequency ventilation to Kerala in 1997and was one of the first to perfect this complicated form of ventilation in India. He also introduced high frequency ventilation in Karnataka. His use of nitric oxide therapy for pulmonary hypertension is also possibly the first in India, and the use of this and other advancements including respiratory mechanics monitoring are expected to place AIMS on par with university hospitals in the US.
While the efficacious use of sildenafil citrate in management of adult hypertension has been reported in March 2002 at the University of Alberta, Edmonton, Canada, its use in the management of neonatal cases must surely be rare. Though the drug is contra-indicated in adults with problems of the heart, liver and kidneys, it acts only locally in newborns, and there are no side effects. Sildenafil citrate works by boosting nitric oxide metabolism in the pulmonary artery, and prevents the breakdown of cyclic guanosine monophosphate by blocking the phosphodiesterase enzyme. The availability of GMP results in enhancing the effects of nitric oxide. The advantages of using sildenafil citrate or Viagra is that, unlike nitric oxide, a regular supply of which is available only in a few centres in India, the drug is easily procured. It also costs Rs 25 per tablet, against Rs 300 per hour of nitric oxide. However, Dr Rajiv cautions against the random use of Viagra. Subsequently, the AIMS team comprising Dr Mathew Kripail, Dr Sunil Mathew and Dr G Sathyajitj Nair, apart from Dr Rajiv, successfully treated two other babies dangerously ill with pulmonary hypertension, and weaned them off the ventilator too. Based on these happy endings, Dr Rajiv has drawn up a protocol for treatment of newborns with pulmonary hypertension. He also intends to follow up on his three "mini-superstars" for at least a year, to check that all goes well. The success of this new form of treatment will mean a new lease of life for the large number of babies who are affected with birth asphyxia or lack of oxygen due to complications during delivery, and pulmonary hypertension. Inappropriately managed, these complications could result in loss of life. Susan Philip Published on 4th July 2002
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Copyright
2008, Chennai Interactive
Business Services (P) Ltd. |
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All the joys associated with parenthood must have taken a severe beating in the case of Sunitha Mohan. Her baby was just eight hours old when she was rushed from Mavelikara to the Neonatology Department of the Amrita Institute of Medical Sciences, Kochi, Kerala, with pulmonary hypertension, a life-threatening situation resulting from the extreme narrowing of blood vessels supplying the lungs. 
As for the use of high frequency ventilation and nitric oxide along with sildenafil citrate to save a critically ill child, it is path-breaking in India and, even in USA, this revolutionary treatment is available only in select centers dealing with new born intensive care. 
