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Standardizing Prostaglandin Initiation in Prenatally Diagnosed Ductal-Dependent Neonates; A Quality Initiative

Brena S Haughey1, Megan R Elliott2, Jaclyn Y Wiggin2

  • 1Department of Pediatrics (Cardiology), University of Virginia, 1204 W. Main St, Charlottesville, VA, 22903, USA.

Pediatric Cardiology
|December 20, 2022
PubMed

Insights

Standardizing prostaglandin E1 (PGE) initiation for congenital heart disease (CHD) reduced side effects like apnea and fever. A 0.01 mcg/kg/min starting dose proved safe and effective in neonates.

Area of Science:

  • Pediatric Cardiology
  • Neonatal Medicine
  • Pharmacology

Background:

  • Prostaglandin E1 (PGE) is crucial for managing ductal-dependent congenital heart disease (CHD).
  • High incidence of dose-dependent side effects (apnea, fever) within 48 hours of PGE initiation was observed.
  • Variability in starting PGE doses complicated management and increased adverse events.

Purpose of the Study:

  • To implement and evaluate a standardized protocol for initiating PGE in neonates with prenatally diagnosed ductal-dependent CHD.
  • To assess the impact of a standardized protocol on the incidence of PGE-related side effects.
  • To determine the safety and efficacy of a standardized starting dose of 0.01 mcg/kg/min.

Main Methods:

  • A standardized PGE initiation protocol was implemented, starting at 0.01 mcg/kg/min.
  • Neonates with prenatally diagnosed ductal-dependent CHD were enrolled (25 pre-intervention, 25 post-intervention).
  • Evaluation focused on protocol compliance, PGE-related side effects, and dose adjustments within 48 hours of initiation.

Main Results:

  • Protocol compliance reached 96% post-intervention.
  • Incidence of apnea or fever significantly decreased from 63% to 28% (p=0.015).
  • No mortalities or emergent procedures occurred; dose adjustments were similar between groups.

Conclusions:

  • Standardizing PGE initiation protocols effectively reduces adverse events like apnea, fever, and sepsis evaluations in neonates with ductal-dependent CHD.
  • A starting dose of 0.01 mcg/kg/min is safe and does not increase adverse effects.
  • Standardized protocols improve patient outcomes and management efficiency for critical congenital heart disease.

Keywords:
InterventionNeonatesOutcomesQuality improvement

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