We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Low-dose prostaglandin E1 is safe and effective for critical congenital heart disease: is it time to revisit the dosing guidelines?
- Authors
Vari, Daniel; Xiao, Wendi; Behere, Shashank; Spurrier, Ellen; Tsuda, Takeshi; Baffa, Jeanne M
- Abstract
<bold>Introduction: </bold>Prostaglandin E1 is used to maintain ductal patency in critical congenital heart disease (CHD). The standard starting dose of prostaglandin E1 is 0.05 µg/kg/minute. Lower doses are frequently used, but the efficacy and safety of a low-dose regimen of prostaglandin E1 has not been established.<bold>Methods: </bold>We investigated neonates with critical CHD who were started on prostaglandin E1 at 0.01 µg/kg/minute. We reviewed 154 consecutive patients who were separated into three anatomical groups: obstruction to systemic circulation, obstruction to pulmonary circulation, and inadequate mixing (d-transposition of the great arteries). Treatment failure rates and two commonly reported side effects, respiratory depression and seizure, were studied.<bold>Results: </bold>A total of 26 patients (17%) required a dose increase in prostaglandin E1. Patients with pulmonary obstruction were more likely to require higher doses than patients with systemic obstruction (15/49, 31% versus 9/88, 10%, p = 0.003). Twenty-eight per cent of patients developed respiratory depression and 8% of patients needed mechanical ventilation. Prematurity (<37 week gestation) was the primary risk factor for respiratory depression. No patient required dose escalation or tracheal intubation while on transport. No patient had a seizure attributed to prostaglandin E1.<bold>Conclusions: </bold>Prostaglandin E1 at an initial and maintenance dose of 0.01 µg/kg/minute was sufficient to maintain ductal patency in 83% of our cohort. The incidence of respiratory depression requiring mechanical ventilation was low and was mostly seen in premature infants. Starting low-dose prostaglandin E1 at 0.01 µg/kg/minute is a safe and effective therapy for critical CHD.
- Subjects
PROSTAGLANDIN E1; CONGENITAL heart disease; DRUG efficacy; PREMATURE infants; APGAR score; RESPIRATORY insufficiency; BODY surface area; PATENT ductus arteriosus; TRANSPOSITION of great vessels; PULMONARY circulation; INTRAVENOUS therapy; ARTIFICIAL respiration; VASODILATORS
- Publication
Cardiology in the Young, 2021, Vol 31, Issue 1, p63
- ISSN
1047-9511
- Publication type
journal article
- DOI
10.1017/S1047951120003297