NICU Medications

Yes, Viagra! Your NICU baby may be receiving Viagra in the hospital, and may be discharged home with it, and, yes, it’s the same medication widely used for erectile dysfunction. ( But it won’t affect your baby in this way, and is OK for baby girls too.) In neonates, this drug is used to treat pulmonary hypertension (see “diagnoses and conditions”). Your baby with PPHN may have been treated with inhaled nitric oxide earlier in his/her life, and now has been transitioned to oral sildenafil. Sildenafil is a vasodilator, a substance that makes blood vessels bigger, allowing them to carry more blood. It works by increasing the amount of a particular enzyme in the bloodstream that keeps vessels dilated, in the same pathway but at a different point from inhaled nitric oxide. Thus, all the blood vessels in the body are dilated, including those in the lungs.

These substances help a newborn baby to breathe and their discovery and development is one of the most important advances in neonatal medicine in the 20th century! A surfactant is a chemical substance that loosens the chemical bonds holding two substances or surfaces together – like the addition of detergent to your dish water to get two stacked glasses apart. The lung is made up of tiny air sacs, like grapes on a stalk, and these air sacs fill up and empty as you inhale and exhale. The inside of the sac is wet and, just like trying to blow up a balloon that has had water in it, the surface tension of the water makes it hard to re-expand the air sac after it has deflated. Our lungs make surfactant, but not until about 36 weeks’ gestational age (one one month before your due date). Without surfactant, it is too hard for a baby to breathe, which is life-threatening. Scientists can extract natural surfactant from cows (Survanta®, Infasurf®) or pigs (Curosurf®) and process it for administration to humans. It is given directly into the newborn lung through a breathing tube placed by a member of your baby’s care team. It is very safe, and the side effects are the same that can be experienced from not having any natural surfactant.

This is an antibiotic that has broad coverage against gram-positive bacteria, including organisms that typically live on the skin. Historically, this antibiotic has been reserved for the most severe gram-positive infections; this wide-spread use has resulted in the development of resistant organisms – primarily in hospitals – that now cannot be treated. Many hospitals restrict the use of vancomycin to proven cases of resistant bacterial infection. NICUs historically have used it freely, as many of the bacteria that cause infection in the growing premie originate from the skin and can only be treated with Vancomycin. Like gentamycin, it can be harmful to the kidneys and/or hearing if used inappropriately.

This is a muscle relaxant/paralytic agent used during procedures or surgery to keep your baby from moving voluntarily. It does not affect what’s called “smooth muscle,” so your baby’s heart will keep beating and the intestines will continue to move and digest food. However, all skeletal muscle movements, including breathing, will be stopped. The medication wears off in about an hour, so repeated doses, or a continuous infusion, may be administered if prolonged paralysis is desired. Vecuronium has no pain relieving or sedative effects. Therefore, it MUST be used in conjunction with some sort of analgesic – either inhaled as during surgery or intravenous/intramuscular. If you think your baby is receiving vecuronium without adequate analgesia, be sure to say something to a nurse or doctor immediately! Vecuronium can make the heart rate increase and can decrease the ability to urinate. There are no other long-term effects.

A benzodiazepine (like Valium®), this medication is frequently used to decrease agitation or activity that may be making your baby worse, or in conjunction with a painful procedure. It can be given either orally or intravenously, and occasionally may be given rectally or intra-nasally. Its main side effect is respiratory depression. Because babies in the NICU are on continuous monitoring for both breathing and heart rate, this is not a major concern, and any effects on breathing can be immediately detected and reversed.

Vitamin D is an essential vitamin for all human beings, vitally important in the metabolism of calcium and phosphorus which relates to bone mineralization and other metabolic functions. Vitamin D can be synthesized by the skin upon exposure to sunlight, but contemporary lifestyles (and sunscreens) impede this process. Deficiency of vitamin D leads to rickets in children and osteoporosis in older individuals. The American Academy of Pediatrics (AAP) has recently recommend that all babies receive vitamin D supplements, from birth onward. The recommended dose is 400 international units (IU) daily.

this is an antacid, also used in adults, that blocks acid secretion in the stomach. Infants who are not feeding into their tummies, or who have the diagnosis of gastroesophageal reflux (GER) may be prescribed Zantac. However, its use in premature babies and neonates is controversial, as it alters the constellation of bacteria normally present in the intestinal tract. If your baby is receiving Zantac, or any other antacid, you should discuss this with your neonatologist.

This drug is used to treat agitation and pain, and to provide light-to-moderate sedation. It is often used in the NICU and PICU, especially with patients who need intubation or mechanical ventilation. The drug is injected either alone or in combination with other drugs to help them work better, and is designed for short-term use of less than 24 hours.

Unlike other drugs used for pain and agitation, dexmetotomidine does not reduce how often the patient breathes per minute, a potentially dangerous complication called “respiratory depression.” This benefit makes dexmetotomidine safer than other drugs commonly used for sedation. And, compared to other sedatives, it also appears to be less likely to cause problems with brain function (called “neurocognitive dysfunction”). Dexmetotomidine has other benefits as well, including a short half-life (meaning that the drug leaves the body faster), a smaller number of adverse effects, and fewer significant interactions with other drugs — all of which make it safer for patients.

Some patients taking the drug experience slower-than-normal heartbeats (bradycardia) and a type of specific problem with the heartbeat (sinoatrial arrest). For this reason, dexmetotomidine should be used cautiously in patients who have advanced heart block. A smaller dose should be used for patients with reduced liver function (hepatic impairment), because it is harder for them to clear the drug from their bodies. And, dexmetotomidine should not be administered using the same IV line as blood or plasma, since its compatibility with those substances has not been established.

Dexmetotomidine is approved for use in adults for sedation before medical procedures, such as surgery, or for those on mechanical ventilation in the ICU. Like many drugs used in the NICU / PICU, dexmetotomidine is not specifically approved for use with neonates. However, a growing body of research indicates that dexmetotomidine is both well-tolerated and safe for use in neonates; its use to provide sedation and pain relief in the NICU/ PICU is based on doctors’ extensive experience with the drug’s overall safety and effectiveness.