Columbus Pediatrician:Viagra, Caffeine, Help Some Premature Babies

On a given day, Nationwide Children's Hospital in Columbus treats about 100 premature infants. But, they're getting some adult medications to stay alive. Doctor Edward Shepherd researches and treats preemies. Babies born too early. And he says has researches looked for ways to keep the infants alive they found caffeine and Sildenafil helps. "Its known best as Viagra. It turns out it also relaxes the vessels in the lungs. And so it's a very, very potent treatment(for) babies who aren't able to come off the ventilator," says Dr.Edward Shepherd. Shepherd says the treatment of some premature infants with small doses of Viagra to help their lungs function is relatively new. He says the smallest infant treated at Children's weighed about 12 ounces, or about the size of a can of soda. ---Click on Listen Icon to hear excerpts of 89.7 WOSU's interview with Dr. Edward Shepherd--- Dr. Shepherd: "The treatment of preemies is a unique field in medicine because its not just medical care, its care that helps a baby develop into a regular person. They are undergoing all the same things outside the uterus they should be undergoing inside the uterus." Q)What is the smallest size of a baby that has been treated at Nationwide Children's Hospital? Shepherd: The smallest baby is about the size and weight of a can of soda, about 12 ounces. Q) Caffeine, Viagra. Those are not things you associate with saving premature infants. Shepherd: No, no indeed those are things that we usually associate with adults. But in fact, for babies who are born early, one of the things that doesn't work very well is their respiratory system. They have trouble breathing, their lungs are underdeveloped. And they forget to breathe. Caffeine it turns out actually helps babies remember to breathe. It tells them to breathe. Not only that but it seems to strengthen their breathing as well. So it's really a remarkable medication for us. Q)How is that you came to discover both caffiene and Sildenifil I guess, is the pharmaceutical name. How is that you discovered that these were helpful to such small infants. Shepherd: Well, with caffeine, we previously had used a medication that's a cousin of caffeine but much more dangerous for babies. And we learned from that that medications like caffeine might have a positive effect and so then of course we did studies. The field of Neonatology did randomized studies where some babies got caffeine and other babies didn't and those babies did better, the ones that got caffeine. They were able to come off the ventilator faster and stay off more successfully. So that's how we learned all about caffeine. Now, Sildenafil is a very interesting story because it wasn't originally studied for the uses that its commonly known for these days. And of course its known best as Viagra. That was a side effect. It was initially studied as a medication to try to help people who had heart problems. To try to help with the pain of heart disease. And it worked okay for that. But they started to notice in some of the men that were taking it it had its other side effects and so that's what they quickly realized would be its most profitable use. But, it turns out it also relaxes the vessels in the lungs. And so it's a very, very potent treatment to help the vessels in the lungs and it turns out some of our most complicated babies, babies who aren't able to come off the ventilator for instance will develop a problem with their lungs where their vessels are too tight. And that makes the right side of the heart pump too hard and that can be deadly, that can actually kill babies. Q)How do thses discoveries come about. In other words have you been treating infants with caffeine and Sildenafil for some time or is this something relatively new? Shepherd: Caffeine,that's been round for awhile. Sildenafil is relatively new. As with most of pediatrics, the way we learn how to treat babies with these medications is by experience. Q) Is it more difficult to get approval from the Food and Drug Administration? Shepherd: It is indeed and many of the medications that we use are not approved by the FDA for the for the treatment that we're using them for, that's common in pediatrics. Especially in intensive care that we have to use drugs in so-called off label way. Q)If breast milk were available would that diminish or eliminate the need for caffeine and Viagra to make these preemies viable? Shepherd: No actually the breast milk comes in fairly quickly. We can't feed very much to these babies. As you can imagine a 12 ounce baby might get one fifth of a teaspoon of breastmilk each feed for the first few weeks and then gradually that goes up. Babies, again, their intestines aren't ready to be outside so they're not designed to handle much in the way of food. There's all kinds of risks to their system if we feed them too fast. But no the caffeine and the rare cases we use Viagra or Sildenafil, those are adjuncts to breastmilk. Those are adjuncts to all the other treatment that we use.