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Published on: May 30, 2019
Plasma-prostaglandins in pre-term neonates before and after treatment for patient ductus arteriosus
Insights
Elevated prostaglandin levels are found in preterm infants with cardiac failure due to patent ductus arteriosus (PDA). These levels may contribute to PDA development and explain indomethacin treatment failures.
Area of Science:
- Neonatal physiology
- Cardiovascular research
- Pharmacology
Background:
- Patent ductus arteriosus (PDA) is a common condition in preterm infants, often leading to cardiac failure.
- Prostaglandins (PGs) are implicated in cardiovascular physiology, but their specific role in PDA pathogenesis is not fully understood.
- Current treatments for PDA, such as indomethacin, have variable success rates.
Purpose of the Study:
- To investigate plasma prostaglandin levels in preterm infants with PDA and cardiac failure.
- To explore the relationship between prostaglandins and PDA pathogenesis.
- To assess the impact of indomethacin treatment on prostaglandin levels.
Main Methods:
- Measurement of plasma prostaglandin levels (PGE, PGF, PGFM) in preterm infants with PDA and cardiac failure.
- Comparison of PG levels with normal preterm infants.
- Analysis of PG levels before and after surgical ligation of the PDA.
- Monitoring PG levels in infants treated with indomethacin, a PG synthetase inhibitor.
Main Results:
- Infants with PDA and cardiac failure exhibited significantly higher plasma levels of PGE, PGF, and PGFM compared to controls.
- Plasma PG levels did not differ before and after surgical PDA ligation.
- Indomethacin treatment initially reduced PG levels, but PGF and PGFM levels rebounded within 48 hours.
- Rebound PG levels may correlate with reported high failure rates of indomethacin for PDA treatment.
Conclusions:
- High plasma prostaglandin levels are associated with PDA and cardiac failure in preterm infants.
- Prostaglandins may play a role in the development of PDA.
- The observed rebound in prostaglandin levels after indomethacin treatment could explain treatment failures.
Abstract:
9 pre-term babies with patent ductus arteriosus (P.D.A.) and cardiac failure were found to have significantly higher plasma-levels of three prostaglandins (P.G.E, P.G.F, and P.G.FM) than a group of normal pre-term infants of the same age. There was no difference in the plasma-prostaglandin levels before and after surgery in the 5 infants who underwent ligation of the ductus, suggesting that the high P.G. levels are not the result of a patent ductus, but that P.G.S may have a role in the pathogenesis of P.D.A. 3 infants who were treated by indomethacin (a P.G. synthetase inhibitor) showed a sharp initial drop in plasma-levels of the three P.G.S, but levels of P.G.F and P.G.FM had risen either during or within 48 h of completion of the course of indomethacin. These results may explain why high failure-rates have been reported for treatment of P.D.A. by indomethacin.
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