[Use of prostaglandins in neonatal cardiology]

The current trend in neonatal cardiology assumes the administration of prostaglandins. Prostaglandins are indicated as a palliative and not definitive therapeutic medicament in neonates with duct dependent congenital heart anomalies. The aim of this study is to evaluate the medicament Prostaglandin, first time administrated to neonatal cardiac patients, in Bosnia and Hercegovina. During December 1997 till June 2000. at the Neonatal department of Pediatric Clinic in Sarajevo 1162 pts were admitted, of which 17 (1.4%) with congenital heart disease have received prostaglandin therapy, with the mean age of 4.5 days (45 minutes till 20 days). 13/17 (76.5%) pts were boys and 4/17 (23.5%) girls, with mean body weight of 3.125 gr (range: 1.250 g to 4.100 g), mean gestational age 40 weeks (range 34 to 42). The patients were admitted for: cyanosis, breathing difficulties or fatigue. Central cyanosis was evident at admission in 15/17 pts, whose oxygen saturation at admission was from 21% up to 76%. The diagnosis of congenital cyanotic heart anomalies was made in 15/17 pts (88%) by clinical examination, X ray, ECG and ultrasound examination and acyanotic duct dependent on 2/17 (12%) pts. The administration of prostaglandin's was necessary and of vital importance for life maintenance of these pts till the surgical correction of these congenital heart anomalies. Prostaglandin E1 (PGE1) was administrated by infusion pump with the mean doses of maintenance: 0.023 mcg/kg/min in 11/17 (65%), and Prostaglandin E2 PGE2 in 6 (35%) pts, maintenance doses of 0.38 mcg/kg/hour. The duration of the prostaglandin application was from 7 hrs up to 30 days, mean 12 days. Five (29.5%) pts were intubatued during the application of this medicament. The side effects of this therapy were present in 13 pts (76.4%): hyperpyrexis in 8, apnea in 2 and apnea + hyperpyrexis in 3 pts. 8/17 (47%) pts were operated and corrected abroad, they are now in good condition, and 9/17 (53%) pts died. The death causes were a part of complex congenital heart disease: impossibility of performing the heart surgery in the country when needed, impossibility of pts evacuation to the foreign cardiosurgical center on time, sepsis or persistent pulmonary hypertension.

In pts with congenital heart disease whose survival is duct dependent, the availability is compulsory and the application of prostaglandins as a palliative medicament. The prostaglandins have made a revolution in saving children's lives in neonatal cardiology.