scholarly journals Side effects of therapy with prostaglandin E1 in infants with critical congenital heart disease.

Circulation ◽  
1981 ◽  
Vol 64 (5) ◽  
pp. 893-898 ◽  
Author(s):  
A B Lewis ◽  
M D Freed ◽  
M A Heymann ◽  
S L Roehl ◽  
R C Kensey
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Side Effects ◽  
Congenital Heart ◽  
Prostaglandin E1 ◽  
Critical Congenital Heart Disease

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

2020 ◽  
pp. 1-8
Author(s):  
Daniel Vari ◽  
Wendi Xiao ◽  
Shashank Behere ◽  
Ellen Spurrier ◽  
Takeshi Tsuda ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Respiratory Depression ◽  
Congenital Heart ◽  
Prostaglandin E1 ◽  
Low Dose ◽  
Systemic Circulation ◽  
Critical Congenital Heart Disease ◽  
Starting Dose

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.

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

2015 ◽  
Vol 37 (1) ◽  
pp. 131-134 ◽  
Author(s):  
Alper Aykanat ◽  
Taner Yavuz ◽  
Elif Özalkaya ◽  
Sevilay Topçuoğlu ◽  
Fahri Ovalı ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Prostaglandin E1 ◽  
Critical Congenital Heart Disease

scholarly journals Caffeine prevents prostaglandin E1-induced disturbances in respiratory control in neonatal rats: implications for infants with critical congenital heart disease

2020 ◽  
Vol 319 (2) ◽  
pp. R233-R242
Author(s):  
L. J. Mitchell ◽  
C. A. Mayer ◽  
A. Mayer ◽  
J. M. Di Fiore ◽  
S. L. Shein ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Prostaglandin E1 ◽  
Neural Control ◽  
Late Phase ◽  
Respiratory Control ◽  
Whole Body ◽  
Neonatal Rats ◽  
Critical Congenital Heart Disease

Continuous infusion of prostaglandin E1 (PGE1) is used to maintain ductus arteriosus patency in infants with critical congenital heart disease, but it can also cause central apnea suggesting an effect on respiratory neural control. In this study, we investigated whether 1) PGE1 inhibits the various phases of the acute hypoxic ventilatory response (HVR; an index of respiratory control dysfunction) and increases apnea incidence in neonatal rats; and 2) whether these changes would be reversible with caffeine pretreatment. Whole body plethysmography was used to assess the HVR and apnea incidence in neonatal rats 2 h following a single bolus intraperitoneal injection of PGE1 with and without prior caffeine treatment. Untreated rats exhibited a biphasic HVR characterized by an initial increase in minute ventilation followed by a ventilatory decline of the late phase (~5th minute) of the HVR. PGE1 had a dose-dependent effect on the HVR. Contrary to our hypothesis, the lowest dose (1 µg/kg) of PGE1 prevented the ventilatory decline of the late phase of the HVR. However, PGE1 tended to increase postsigh apnea incidence and the coefficient of variability (CV) of breathing frequency, suggesting increased respiratory instability. PGE1 also decreased brainstem microglia mRNA and increased neuronal nitric oxide synthase (nNOS) and platelet-derived growth factor-β (PDGF-β) gene expression. Caffeine pretreatment prevented these effects of PGE1, and the adenosine A2A receptor inhibitor MSX-3 had similar preventative effects. Prostaglandin appears to have deleterious effects on brainstem respiratory control regions, possibly involving a microglial-dependent mechanism. The compensatory effects of caffeine or MSX-3 treatment raises the question of whether prostaglandin may also operate on an adenosine-dependent pathway.

scholarly journals Congenital Heart Disease Requiring Maintenance of Ductus Arteriosus in Critically Ill Newborns Admitted at A Tertiary Neonatal Intensive Care Unit

2016 ◽  
Vol 2 (4) ◽  
pp. 185-191 ◽  
Author(s):  
Manuela Cucerea ◽  
Marta Simon ◽  
Elena Moldovan ◽  
Marcela Ungureanu ◽  
Raluca Marian ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Side Effects ◽  
Pulmonary Circulation ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Ductus Arteriosus ◽  
Prostaglandin E ◽  
Critical Congenital Heart Disease ◽  
The Mean

AbstractIntroduction: Congenital heart diseases (CHD) have been reported to be responsible for 30 to 50% of infant mortality caused by congenital disabilities. In critical cases, survival of newborns with CHD depends on the patency of the ductus arteriosus (PDA), for maintaining the systemic or pulmonary circulation. The aim of the study was to assess the efficacy and side effects of PGE (prostaglandin E) administration in newborns with critical congenital heart disease requiring maintenance of the ductus arteriosus.Material and method: All clinical and paraclinical data of 66 infants admitted to one referral tertiary level academic center and treated with Alprostadil were analyzed. Patients were divided into three groups: Group 1: PDA dependent pulmonary circulation (n=11) Group 2: PDA dependent systemic circulation (n=31) Group 3: PDA depending mixed circulation (n=24)Results: The mean age of starting PGE1 treatment was 2.06 days, 1.91 (+/−1.44) days for PDA depending pulmonary flow, 2.39 (+/−1.62) days for PDA depending systemic flow and 1.71 (+/1.12) for PDA depending mixing circulation. PEG1 initiation was commenced 48 hours after admission for 72%, between 48-72 hours for 6%, and after 72 to 120 hours for 21% of newborns detected with PDA dependent circulation. Before PEG1 initiation the mean initial SpO2 was 77.89 (+/− 9.2)% and mean initial oxygen pressure (PaO2) was 26.96(+/−6.45) mmHg. At the point when stable wide open PDA was achieved their mean SpO2increased to 89.73 (+/−8.4)%, and PaO2 rose to 49 (+/−7.2) mmHg. During PGE1 treatment, eleven infants (16.7%) had apnea attacks, five children (7.5%) had convulsions, 33 (50%) had fever, 47 (71.2%) had leukocytosis, 52 (78.8%) had edema, 25.8% had gastrointestinal intolerance, 45.5% had hypokalemia, and 63.6% had irritability.Conclusions: For those infants with severe cyanosis or shock caused by PDA dependent heart lesions, the initiation and maintenance of PGE1 infusion is imperative. The side effects of this beneficial therapy were transient and treatable.

scholarly journals Effects of prostaglandin E1 infusion in the pre-operative management of critical congenital heart disease.

1985 ◽  
Vol 146 (2) ◽  
pp. 237-249 ◽  
Author(s):  
TOSHIO OHARA ◽  
HIROSHI OGATA ◽  
JUN-ICHI FUJIYAMA ◽  
YUJI MURATA ◽  
JUN-ICHIRO ABE ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Prostaglandin E1 ◽  
Operative Management ◽  
Critical Congenital Heart Disease

PROSTAGLANDIN E1 ADMINISTRATION TO PATIENTS WITH THE DUCTUS-DEPENDENT CONGENITAL HEART DISEASE

1990 ◽  
Vol 40 (6) ◽  
pp. 765-771
Author(s):  
KATSUHIKO SONE ◽  
TOSHIHIRO KOBAYASHI ◽  
TOMIO KOBAYASHI ◽  
TAKASHI KOSUDA ◽  
SANAYASU ONO ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Prostaglandin E1

scholarly journals Pulse Oximetry Screening Has Not Changed Timing of Diagnosis or Mortality of Critical Congenital Heart Disease

2020 ◽  
Vol 41 (5) ◽  
pp. 899-904 ◽  
Author(s):  
Matthew J. Campbell ◽  
William O. Quarshie ◽  
Jennifer Faerber ◽  
David J. Goldberg ◽  
Christopher E. Mascio ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Pulse Oximetry ◽  
Congenital Heart ◽  
Critical Congenital Heart Disease ◽  
Pulse Oximetry Screening

A retrospective analysis of a pediatric tele-echocardiography service to treat, triage, and reduce trans-Pacific transport

2017 ◽  
Vol 24 (3) ◽  
pp. 224-229 ◽  
Author(s):  
Christopher A Rouse ◽  
Brandon T Woods ◽  
C Becket Mahnke
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Ductus Arteriosus ◽  
Tertiary Care ◽  
The United States ◽  
Critical Congenital Heart Disease ◽  
Medical Centers ◽  
Prompt Diagnosis ◽  
Patent Ductus

Introduction Tele-echocardiography can ensure prompt diagnosis and prevent the unnecessary transport of infants without critical congenital heart disease, particularly at isolated locations lacking access to tertiary care medical centers. Methods We retrospectively reviewed all infants who underwent tele-echocardiography at a remote 16-bed level IIIB NICU from June 2005 to March 2014. Tele-echocardiograms were completed by cardiac sonographers in Okinawa, Japan, and transmitted asynchronously for review by pediatric cardiologists in Hawaii. Results During the study period 100 infants received 192 tele-echocardiograms: 46% of infants had tele-echocardiograms completed for suspected patent ductus arteriosus, 28% for suspected congenital heart disease, 12% for possible congenital heart disease in the setting of likely pulmonary hypertension, and 10% for possible congenital heart disease in the setting of other congenital anomalies. Of these, 17 patients were aeromedically evacuated for cardiac reasons; 12 patients were transported to Hawaii, while five patients with complex heart disease were transported directly to the United States mainland for interventional cardiac capabilities not available in Hawaii. Discussion This study demonstrates the use of tele-echocardiography to guide treatment, reduce long and potentially risky trans-Pacific transports, and triage transports to destination centers with the most appropriate cardiac capabilities.

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