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Bone and tissue changes following prostaglandin therapy in neonates
1St John's University College of Pharmacy and Allied Health Professions, Jamaica, NY, USA.
Insights
Prostaglandin therapy in neonates can cause bone changes and swelling. Monitoring alkaline phosphatase (AP) may help predict or prevent complications from these skeletal effects.
Area of Science:
- Neonatal pharmacology
- Pediatric skeletal radiology
- Adverse drug reactions
Background:
- Prostaglandin infusions are used in neonates for various conditions.
- Potential adverse effects, including skeletal changes, require careful consideration.
Purpose of the Study:
- To review case reports of bone changes and tissue swelling in neonates due to prostaglandin therapy.
- To inform healthcare providers about these potential complications.
Main Methods:
- Literature search of English-language case reports using Index Medicus and bibliographic databases.
- Focus on prostaglandin-induced bone changes and tissue swelling in neonates.
Main Results:
- Prostaglandin infusion is linked to cortical bone proliferation in neonates.
- Observed skeletal changes include widened fontanelles and limb swelling, potentially lasting up to 38 weeks post-therapy.
- Elevated alkaline phosphatase (AP) levels were noted in some cases, suggesting it as a potential monitoring marker.
Conclusions:
- Healthcare professionals should be aware of prostaglandin-induced skeletal changes in neonates.
- Optimizing dosage and limiting exposure duration are recommended.
- Monitoring AP levels may aid in predicting or preventing complications.
Objective:
To review case reports describing prostaglandin-induced bone changes and tissue swelling in neonates.
Data Sources:
An Index Medicus and bibliographic search of the English-language literature pertaining to prostaglandin-induced bone changes and tissue swelling in neonates.
Data Synthesis:
Short- and long-term prostaglandin infusion in neonates is associated with cortical proliferation throughout the skeletal system. Total resolution of these changes has occurred in seven patients described to date; other reports did not note either the time or the regression of these changes. Skeletal changes may occur within 9 days of initiation of prostaglandin therapy and include widened fontanelles, pretibial and soft-tissue swelling, and swelling of the upper and lower extremities. These reactions may last up to 38 weeks following discontinuation of therapy. Alkaline phosphatase (AP) concentrations have been shown to be increased in four cases, as well as in one retrospective analysis. Although these were not prospective studies, evaluation of AP may provide a means to monitor neonates receiving prostaglandin therapy.
Conclusions:
Pharmacists need to be aware of the potentially serious skeletal changes, encourage dosage titration as soon as possible, and limit the duration of time neonates are exposed to prostaglandin therapy. Monitoring of AP concentrations during therapy with prostaglandins may be beneficial in predicting or preventing further complications.