Long-Term Prostaglandin E1 Infusion for Newborns with Critical Congenital Heart Disease

Abstract

Prostaglandin E1 is crucial for keeping the patent ductus arteriosus in critical congenital heart disease for the survival and palliation of particularly prematurely born babies until a cardiosurgical intervention is available. In this study, the side effects of prostaglandin E1 in newborns with critical congenital heart disease and clinical outcomes were evaluated. Thirty-five newborns diagnosed with critical congenital heart disease were treated with prostaglandin E1 between January 2012 and September 2014 at our hospital. Patient charts were examined for prostaglandin E1 side effects (metabolic, gastric outlet obstruction, apnea), clinical status, and prognosis. Acquired data were analyzed in the SPSS 20.0 program. Patients with birth weight under 2500 g needed more days of prostaglandin E1 infusion than ones with birthweight over 2500 g (P = 0.016). The ratio of patients with birth weight under 2500 g who received prostaglandin E1 longer than 7 days was higher than the patients with birth weight over 2500 g (P = 0.02). Eighteen side effects were encountered in 11 of 35 patients (31%). Of these side effects, 1 patient had 4, 4 patients had 2, and 6 patients had only 1 side effect. Discontinuation of the therapy was never needed. Prostaglandin E1 is an accepted therapy modality for survival and outcome in critical congenital heart disease in particularly low-birth-weight babies until a surgical intervention is available. Side effects are not less encountered but are almost always manageable, and discontinuation is not needed.

Tricuspid atresia: Where are we now?

“…23 However, many of these side effects are manageable and should not deter clinicians from using PGE1 in newborns with CHD. 23 In cases of TA with reduced PBF and cyanosis, patients may also undergo surgery to have a polytetrafluoroethylene conduit fitted between the right subclavian artery and right pulmonary artery. 27 This is known as a modified Blalock-Thomas-Taussig shunt (MBTS) and like PGE1, it also enables temporary mixing of the systemic and pulmonary circulations.…”

“…These take a significant amount of time and resources to organize. Prostaglandin E1 (PGE1) can therefore be given in the meantime to maintain a PDA 23 . This is a potentially life‐saving intervention in cases of TA with reduced PBF, as these infants rely on a PDA for the pulmonary and systemic circulations to mix 24 .…”

“…However, a recent systematic review published by the Cochrane Database has highlighted the lack of randomized controlled trials (RCTs) focusing on the safety and efficacy of PGE1 in neonates with ductal‐dependent cardiac lesions 24 . In addition, the use of PGE1 in newborns has been associated with numerous adverse effects, such as fever (which could delay surgical management), 25 hypokalemia, hypotension, 26 apnea, and gastric outlet syndrome 23 . However, many of these side effects are manageable and should not deter clinicians from using PGE1 in newborns with CHD 23 …”

Interventional effect of off-label use of alprostadil lipid microsphere injection in neurosurgical patients: a before-after study

“…Alprostadil is a stable prostaglandin E 1 analogue that demonstrates activity inhibiting platelet aggregation, relaxing smooth muscle of peripheral blood vessels, anti-oxidation, endothelium protection and stabilizing liver cell membrane [1][2][3][4]. For this reason, intravenous or intraarterial administration has been successfully used in the management of critical leg ischemia, angiospastic disorders, Raynaud's phenomenon, diabetic peripheral neuropathy, diabetic foot, liver transplantation, etc [5][6][7][8]. The conventional preparation of alprostadil has a half-life of only 3-5 minutes and is metabolized rapidly, so constant administration is required.…”

A bifunctional catalyst based ECL immunosensor for a cardiac biomarker regulated by oxygen evolution reaction

“…Prostaglandin E1 (PGE1), is a pivotal member of the prostaglandin family which are cyclic, oxygenated fatty acids that exert diverse and powerful effects on cell function in many organ systems [1,2]. As a product of arachidonic acid metabolism by cyclooxygenase, PGE1 is associated with pro-and anti-inflammatory actions [2], osteoporosis, and some studies have found PGE1 could reduce the compression trauma-induced spinal cord injury and had beneficial effect on osteoporosis management [3,4]. Additionally, PGE1, as a potent vasodilator, has beneficial hemodynamic effects on patients with severe heart failure by increasing cardiac output and decreasing filling pressures and pulmonary vascular resistance [5].…”