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Prostaglandin E1 in infants with congenital heart disease: Indian experience
A Saxena1, M Sharma, S S Kothari
1Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India.
Insights
Prostaglandin E1 (PGE1) effectively maintains ductus arteriosus patency in infants with congenital heart disease, even beyond the neonatal period. Close monitoring for side effects like apnea is crucial for safe and effective use.
Area of Science:
- Neonatal cardiology
- Pediatric cardiovascular surgery
- Pharmacology
Background:
- E-type prostaglandins (PGE1) are vital for maintaining ductus arteriosus patency in neonates with ductus-dependent congenital heart disease.
- While available for decades in Western countries, PGE1 was introduced in India in 1995.
Purpose of the Study:
- To evaluate the efficacy of Prostaglandin E1 (PGE1) in treating infants with ductus-dependent congenital heart disease at the study center.
- To assess the safety and effectiveness of PGE1 in a diverse group of infants, including those older than one week.
Main Methods:
- A hospital-based study included 65 infants with ductus-dependent congenital heart disease.
- PGE1 infusion was initiated at 0.05 microgram/kg/min, reduced to 0.005-0.01 microgram/kg/min for maintenance.
- Efficacy was assessed by monitoring oxygen saturation, peripheral pulses, and echocardiographic measurements based on specific cardiac defect categories.
Main Results:
- PGE1 was successful in 62 out of 65 infants (95.4% efficacy).
- Two cases failed due to severe comorbidities; one infant experienced a skin rash, and another could not tolerate the infusion.
- Side effects included apnea in 9% of spontaneously breathing patients, with other rare occurrences like necrotizing enterocolitis and hyperpyrexia. Six deaths occurred, two potentially related to PGE1.
Conclusions:
- PGE1 is a highly effective medication for maintaining ductus arteriosus patency in infants with ductus-dependent congenital heart disease.
- The drug demonstrates efficacy even in neonates older than the first week of life.
- Apnea is a significant side effect, necessitating close patient monitoring during PGE1 therapy.
Background:
E-type prostaglandins (PGE1) can effectively maintain the patency of the ductus arteriosus in neonates. Its use, therefore and be life saving in infants born with ductus dependent congenital heart disease. Although PGE1 is available for over two decade in western world, it has been introduced in India only since April, 1995.
Objective:
To assess the efficacy of PGE1 at our center.
Setting:
Hospital based.
Method:
65 infants with ductus dependent congenital heart disease were included. Age at time of starting PGE1 infusion ranged from 18 hours to 39 days. Forty two of these were more than a week of age, 19 were more than 14 days, and two were above one month. PGE1 was started in an initial dose of 0.05 microgram/kg/min, decreased to 0.005-0.01 microgram/kg/min for maintenance. The indications for use of PGE1 were to increase pulmonary blood flow in 33 cases with pulmonary atresia, tricuspid atresia or critical pulmonic stenosis (Group I); to increase systemic blood flow in 15 cases with coarctation of aorta, hypoplastic left heart and interruption of aortic arch (Group II); to improve mixing in 13 cases of transposition of great arteries (Group III) and for improving the left ventricular volumes by keeping the duct open in 4 cases of transposition of great arteries with intact ventricular septum (Group IV). The efficacy of the drug was assessed by a rise on PaO2 and SaO2% determined for Group I & III, and by appearance of lower limbs pulses in Group II. Left ventricular volumes were serially measured by echocardiography in Group IV cases.
Results:
The drug was successful in 62 of the 65 cases. There were two failures. One was a 39 days old baby with Ebstein's anomaly of tricuspid valve and pulmonary atresia and other was an eight days old baby with coarctation of aorta and renal failure. In addition, PGE1 could not be continued in another baby due to development of a linear skin rash locally. Side effects included apnea in 5 (9%) of 56 spontaneously breathing patients. Necrotizing enterocolitis, hyperpyrexia and jitteriness was sent in one case each. Six patients died. Two were related to PGE1, one due to failure, another due to its side effects. Definitive procedure were performed in 51 cases electively. PGE1 was used upto 13 days with sustained benefit.
Conclusions:
PGE1 is an effective drug for keeping the ductus open in infants with ductus dependent congenital heart disease. It can be used for neonates beyond the first week of life with efficacy. Apnea is a major side effect and close monitoring is essential.