Related Experiment Videos
Prostaglandin-induced neonatal periostitis
1Division of Orthopaedics, Children's Hospital of Eastern Ontario, University of Ottawa, Canada.
Insights
Prostaglandin treatment for congenital heart defects in infants can cause periostitis, a bone inflammation. This side effect, linked to treatment duration, resolves after discontinuing the medication.
Area of Science:
- Pediatric Cardiology
- Neonatal Medicine
- Pediatric Orthopedics
Background:
- Prostaglandins are crucial for maintaining ductus arteriosus patency in infants with ductal-dependent congenital heart disease.
- A rare but significant side effect of prostaglandin therapy is symmetrical periostitis of the long bones.
Purpose of the Study:
- To describe the clinical presentation, onset, and resolution of periostitis in neonates treated with prostaglandins.
- To investigate the relationship between prostaglandin dosage, duration of treatment, and the development of periostitis.
Main Methods:
- Retrospective review of neonates with congenital heart disease treated with prostaglandins at a children's hospital.
- Analysis of clinical data including prostaglandin dosage, infusion duration, onset of symptoms, and radiographic findings.
Main Results:
- Five infants developed periostitis, with onset occurring after at least 14 days of prostaglandin infusion.
- Periostitis was associated with limb pain and extremity swelling, and improved significantly within 6 weeks of discontinuing prostaglandin therapy.
- The duration of prostaglandin administration appeared to be a more significant factor than dosage in the development of periostitis.
Conclusions:
- Prostaglandin-induced periostitis is an important consideration in neonates receiving this therapy.
- Awareness of this condition is crucial for clinical teams and pediatric orthopedists to prevent misdiagnosis and unnecessary investigations.
- Early recognition and cessation of prostaglandin infusion can lead to resolution of periostitis.
Abstract:
Prostaglandins are being commonly used to maintain the patency of the ductus arteriosus in infants with congenital ductal-dependent heart disease. A significant and unusual side effect of this drug treatment is the symmetrical development of periostitis of the long bones. A review of neonates with congenital heart disease requiring prostaglandin treatment at the Children's Hospital of Eastern Ontario revealed five infants who developed periostitis, the earliest onset being after 14 days of prostaglandin infusion. The drug dosage varied in these infants from 0.02 to 0.10 micrograms/kg/min. The periostitis was associated with limb pain and considerable swelling of the extremities in all children. The periostitis improved on cessation of the prostaglandin infusion, and by 6 weeks after the cessation of the drug, the periostitis had decreased significantly. Periostitis seemed more dependent on the duration of administration of the prostaglandin than on the dosage of prostaglandin administered. Awareness of this entity is essential not only for the treatment team caring for these infants but also for consultant pediatric orthopaedists to avoid excessive investigation for infection, metabolic disease, or vitamin deficiencies that resemble prostaglandin-induced periostitis.