Side-effects of long-term prostaglandin E(1) treatment in neonates

Area of Science:

• Neonatal Cardiology
• Pediatric Pharmacology

Background:

• Prostaglandin E1 (PGE1) therapy is sometimes necessary for neonates with ductus arteriosus-dependent congenital heart defects for over two weeks.
• PGE1 analogues can lead to various adverse effects.

Purpose of the Study:

• To evaluate the adverse effects and clinical outcomes of prolonged Prostaglandin E1 (PGE1) treatment in neonates.
• To identify potential dose-dependent relationships between PGE1 therapy duration and adverse events.

Main Methods:

• Retrospective analysis of nine neonates receiving PGE1 treatment for more than 14 days.
• Monitoring of leukocyte counts, clinical symptoms, and biochemical parameters, including electrolytes and bicarbonate levels.

Main Results:

• Persistent high leukocyte and neutrophil counts were observed.
• Two patients experienced feeding difficulties and abdominal distension, with possible gastric-outlet obstruction.
• Three patients developed cortical hyperostosis and a pseudo-Bartter syndrome-like condition, particularly with higher cumulative PGE1 doses.
• Significant correlations were found between PGE1 dose and serum K+ levels (r=-0.770) and blood bicarbonate levels (r=0.889).

Conclusions:

• Frequent monitoring of fluid-electrolyte parameters is crucial for neonates on PGE1 therapy exceeding two weeks.
• Fluid-electrolyte disturbances and pseudo-Bartter syndrome appear to be more dose-dependent than cortical hyperostosis.
• Individual susceptibility, dose, and therapy length are important factors in adverse event development.