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Prostaglandin induced cortical hyperostosis in neonates with cyanotic heart disease
A M Nadroo1, S Shringari, M Garg
1Department of Pediatrics, Maternity and Children Hospital, Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia. Anadroo@yahoo.com
Insights
Prolonged prostaglandin therapy in neonates can cause hyperostosis and musculoskeletal changes. Other side effects include abnormal facial features and elevated alkaline phosphatase, suggesting dose and duration dependency.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Pharmacology
Background:
- Prostaglandin therapy is crucial for neonates with cyanotic heart disease.
- Prolonged use may lead to adverse effects, particularly musculoskeletal changes.
Purpose of the Study:
- To investigate the side effects of extended prostaglandin therapy in neonates.
- Specifically focusing on hyperostosis and other musculoskeletal alterations.
Main Methods:
- Retrospective review of case files of neonates with cyanotic heart disease receiving prostaglandin infusion.
- Analysis of radiographs, serum alkaline phosphatase levels, and prostaglandin dosage/duration.
Main Results:
- Ten patients developed hyperostosis after 9-195 days of PGE1 infusion.
- Two neonates exhibited coarse facial features, hypertrichosis, edema, and digital swelling.
- Significantly elevated serum alkaline phosphatase was observed in patients with hyperostosis, including clavicular involvement.
Conclusions:
- Hyperostosis is a frequent adverse effect of prolonged prostaglandin therapy.
- Long-term therapy can also cause abnormal facial features and skin changes.
- Serum alkaline phosphatase serves as a marker for hyperostosis, which can affect clavicles and is dose/duration dependent.
Objective:
To study the side effects of prolonged prostaglandin therapy especially hyperostosis and other musculoskeletal changes.
Methods:
Case files of the neonates, with cyanotic heart disease, who had received prostaglandin infusion from early days of life, were reviewed. Patients with periosteal changes were identified. Their radiographs, serum alkaline phosphatase activity, duration and dose of prostaglandin and other side effects related to the prostaglandin were studied.
Results:
Ten patients developed hyperostosis, who had received PGE1 infusion for a period of 9 to 195 days. Two babies developed coarse facial features, hypertrichosis, and edema of extremities and digital swelling. Serum alkaline phosphatase activity was significantly raised in the patients, with hyperostosis. Besides long bones, ribs and scapulae, the clavicles were also involved. The involvement of clavicles has not been previously reported.
Conclusion:
Hyperostosis is a common side effect of prolonged prostaglandin therapy. Abnormal facial features, hypertrichosis and coarse skin are additional adverse effects of long term therapy. Serum alkaline phosphatase activity can be used as a marker of the hyperostosis. In addition to other bones clavicles can also be involved. The above effects seem to be both dose and duration dependent.