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Low-dose prostaglandin E1 is safe and effective for critical congenital heart disease: is it time to revisit the dosing guidelines?

Published online by Cambridge University Press:  03 November 2020

Daniel Vari Open the ORCID record for Daniel Vari [Opens in a new window] ,
Wendi Xiao ,
Shashank Behere ,
Ellen Spurrier ,
Takeshi Tsuda Open the ORCID record for Takeshi Tsuda [Opens in a new window]  and
Jeanne M. Baffa
Daniel Vari
Affiliation:
Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
Wendi Xiao
Affiliation:
Department of Biostatistics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
Shashank Behere
Affiliation:
Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
Ellen Spurrier
Affiliation:
Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
Takeshi Tsuda*
Affiliation:
Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
Jeanne M. Baffa
Affiliation:
Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
*
Author for correspondence: Takeshi Tsuda, Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd., Wilmington, DE19803, USA. Tel: +1 302 651 6677; Fax: +1 302 651 6601. E-mail: ttsuda@nemours.org
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Abstract

Introduction:

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.

Methods:

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.

Results:

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.

Conclusions:

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.

Keywords

CHDpatent ductus arteriosusprostaglandin E1side effectsapnoeamechanical ventilation
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 1 , January 2021 , pp. 63 - 70
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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Footnotes

†

Current address: The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA.

§

Current address: Department of Pediatric Cardiology, Oklahoma University Health Sciences Center, 1200 Children’s Ave., Oklahoma City, OK 73104, USA.

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