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Prostaglandin F1 alpha levels during and after neonatal extracorporeal membrane oxygenation
M P Leuschen1, J A Ehrenfried, L D Willett
1Joint Division of Newborn Medicine, Creighton University-University of Nebraska Medical Center, Omaha 68105.
Insights
Prostacyclin metabolite levels (prostaglandin F1 alpha) were elevated in neonates during extracorporeal membrane oxygenation (ECMO) therapy. These levels fluctuated during ECMO and after treatment, impacting vasomotor tone and platelet function in critically ill infants.
Area of Science:
- Neonatal research
- Cardiovascular physiology
- Biochemistry
Background:
- Infants on extracorporeal membrane oxygenation (ECMO) experience prolonged cardiopulmonary bypass and systemic heparinization.
- Prostacyclin, a vasodilator and platelet aggregation inhibitor, is crucial in cardiovascular homeostasis.
- Its metabolite, prostaglandin F1 alpha (PGF1α), is a marker for prostacyclin activity.
Purpose of the Study:
- To investigate the impact of long-term extracorporeal membrane oxygenation on prostacyclin metabolite levels in neonates.
- To correlate PGF1α levels with ECMO duration and clinical course.
- To understand the implications for managing vasomotor tone and hemorrhage risk.
Main Methods:
- Plasma samples were collected from 10 neonates during and after ECMO therapy.
- Prostaglandin F1 alpha (PGF1α) levels were quantified using radioimmunoassay.
- Measurements were taken in picograms per milliliter.
Main Results:
- PGF1α levels were elevated during ECMO therapy.
- A decrease in PGF1α levels was observed with increasing ECMO duration.
- PGF1α levels often increased during weaning from ECMO and remained elevated for 24 hours post-therapy.
Conclusions:
- Circulating PGF1α levels are significantly influenced by the extracorporeal membrane oxygenation course in neonates.
- Fluctuating PGF1α levels suggest a dynamic impact on vasomotor tone and platelet function.
- Monitoring PGF1α may be clinically relevant for managing critically ill infants undergoing ECMO, particularly concerning hemorrhage prevention.
Abstract:
Infants receiving extracorporeal membrane oxygenation therapy undergo long-term cardiopulmonary bypass, are systemically heparinized, and frequently receive platelet transfusions. Prostacyclin is a powerful inhibitor of platelet aggregation as well as a potent vasodilator. The levels of its stable metabolite prostaglandin F1 alpha increase significantly in children undergoing cardiopulmonary bypass during heart operations but decrease to preoperative levels after bypass. To determine the effect of long-term bypass on prostacyclin levels, multiple plasma samples were analyzed in 10 human neonates both during extracorporeal membrane oxygenation therapy and within 24 hours after extracorporeal membrane oxygenation. Prostaglandin F1 alpha, the stable metabolite of prostacyclin, was quantitated by radioimmunoassay in picograms per milliliter. Prostaglandin F1 alpha levels were elevated while the patients received extracorporeal membrane oxygenation therapy but decreased with duration of extracorporeal membrane oxygenation. In most infants, prostaglandin F1 alpha levels rose again during weaning from extracorporeal membrane oxygenation and remained elevated for 24 hours after extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation course influenced circulating prostaglandin F1 alpha levels. Fluctuating prostaglandin F1 alpha levels are of clinical significance in the management of vasomotor tone and platelet function, common problems in the care and the prevention of hemorrhage in these critically ill infants.
