According to media reports, the anti-impotence drug Viagra was recently used in the UK to save the life of a premature infant. Yes, you did read that right. This case was apparently an instance where necessity and desperation were the mothers of invention, and it shows us just why it is so important for doctors to learn the basics of human physiology, instead of just "cookbook" medicine. It also shows the scientific method at work, in a real-life situation.
The problem was this: the baby, Lewis Goodfellow, was born extraordinarily prematurely, after only 24 weeks of gestation, and weighed in at only 1 pound 8 ounces (680g). That's unimaginably tiny - my own son was born at 28 weeks, weighing a bit over 2 pounds, and that was smaller than I thought possible.
Anyway, a common problem with infants who are that small and that premature is lung development. The lungs have not yet developed a blood supply good enough to circulate all the necessary oxygen. That's a very bad situation, because it means that supplying more oxygen to the infant won't fix it, even if a respirator is used to do the breathing. The major problem isn't getting the oxygen into the lungs, it's getting it from the lungs to the rest of the body.
So why did the doctors go for the Viagra?
Viagra, like its competitors Cialis and Levitra (I think I just guaranteed that this post will get stuck in everybody's spam filters), works by interfering with the action of an enzyme (PDE5). Blocking the action of this enzyme, which is found in penile tissues, relaxes the arteries in those tissues. Relaxing the arteries increases the bloodflow, and results in very happy men - particularly when it hasn't happened in a while.
As it turns out, PDE5 isn't just found in the penis. It's also found in the lung. The doctors administered the viagra in an attempt to get the arteries in the baby's lungs (lung, actually, since the poor kid only had one that was working at that point) to relax. It worked. The relaxed arteries were able to carry more oxygen, and the baby didn't die.
There's a lot more to good medical care than just making a diagnosis and carrying out treatments. The doctors in this case definitely proved that.
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Being born at 30 weeks is very, very different from being born at 24 weeks. Even being born at 25 weeks confers a significant advantage over being born at 24 weeks(see here). It's hard to say there is any meaningful equivalency of disability risk between you and any 24-weeker. Sorry.
That said, you make an excellent point about the worth of the lives of disabled people, and I freely cop to having biases in this regard. That said, there are many reasons possible disability would be preferred to death--reasons that have nothing to do with worth as a human being, and everything to do with the level of resources available to provide physical and emotional nourishment to a disabled child.
Many of the people who work most closely with premature babies and their families would argue that we should be allowing high-risk babies to die peacefully more often than we do.
Mike, I might also note that this case illustrates why physicians are permitted to prescribe drugs "off-label" (i.e., for indications other than those for which the drug is approved.). The latitude given to docs who maintain their solid basic science backgrounds pays dividends for us because it is doubtful that any maker of a PDE5 inhibitor would go through the hassle of getting their drug approved for preemie infants.
Of course, there are always abuses of allowances for good intentions, but off-label prescribing is generally a good thing.
Very nice post! As a basic scientist who teaches physiology to medical students, I try to convince them by examples like the one you described that--while medicine may be 95% pattern recognition--success with the 5% that is not requires a deep knowledge of physiology.
Yay! Now that baby can go on to grow up and become a disabled, possibly ventilator-dependent child! Goooo, science!
Sorry. After a month in the NICU, I'm not convinced that aggressive resuscitation of 24-week-old premies is so great, even if it demonstrates how smart we are.
Signout, As a 2 1/2 month early, 2pound 3oz preemie I'll have to respectfully disagree. Possible disability and the possible need to use a ventilator as a child should not equal one's worth as a human being. The alternative was to let the kid die since they couldn't breathe, if I'm not mistaken? Why would possible disability be prefered to death?