Role of Sildenafil in Severe COVID-19 Pneumonia in Infancy - A Case Series

SARS-CoV-2 virus primarily affects the respiratory system, although other organ systems are also involved. Though pulmonary arterial hypertension (PAH) has been described in as a sequela of COVID pneumonia in adults, only a coincidental association between pre-existing PAH and SARS-CoV-2 infection in children has been reported. To our knowledge, severe COVID pneumoniacausing PAH in children, especially in infancy has not been reported yet. With the meteoric spread of the pandemic and rapid development of newer mutated variants, the timely discovery of new drugs is near impossible. The idea of repurposing existing drugs to treat COVID-19 is an attractive strategy, especially if they are already approved (for other indications) and have wellestablished safety profiles. Sildenafil specifically targets pulmonary vasodilation, endothelial function, and vascular remodelling. It hence has emerged as an effective first - line oral therapeutic agent for patients with symptomatic PAH in all age groups. We present a case series of four cases where Sildenafil has been repurposed for the treatment of PAH associated with severe COVID-19 pneumonia in infancy.