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Palmero D, Chavan E, Berger-Gryllaki M, Tolsa JF, Di Paolo ER, Pannatier A, Henry H, Sadeghipour F. Stability of prostaglandin E 1 solutions stored in polypropylene syringes for continuous intravenous administration to newborns. Eur J Hosp Pharm 2019; 25:e109-e114. [PMID: 31157079 DOI: 10.1136/ejhpharm-2017-001205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 05/17/2017] [Accepted: 06/12/2017] [Indexed: 11/04/2022] Open
Abstract
Objective We aimed to monitor the physicochemical stability of prostaglandin E1 (PGE1) 1.5 and 15 µg/mL in 10% dextrose stored in polypropylene syringes. Methods We developed a liquid chromatography-high resolution mass spectrometry (LC-HRMS) method to detect and quantify levels of PGE1. Method selectivity was performed with a mixture of PGE1 and its degradation products. Forced degradation tests were performed to determine which degradation products were most likely to form. PGE1 injection solutions in 10% dextrose were stored in unprotected and shielded-from-light polypropylene syringes in a climatic chamber. Samples were taken immediately after preparation (T0) and after 24, 48, 72 and 168 hours for analysis. PGE1 solutions were considered stable if ≥90.0% of the initial concentration was retained. Results The LC-HRMS method was validated in the range of 0.086-0.200µg/mL PGE1 with trueness values between 98.2% and 100.3%, and repeatability and intermediate precision values of <2.2%and <4.7%, respectively. The quantification and detection limits of the method were 0.086 and 0.026µg/mL, respectively. PGE1 and its degradation products were resolved chromatographically. PGE1 injection solutions were≥90.0%stable after 48hours in unprotected from light (UPL) syringes. The solutions remained clear without precipitation, colour or pH modification and subvisible particles within the permitted levels. Prostaglandin A1 was the sole degradation product observed. Conclusions A LC-HRMS method to evaluate PGE1 stability in a 10% dextrose was developed and validated. PGE1 1.5 and 15µg/mL in 10% dextrose solution are stable for 48hours when stored at 30ºC in UPL polypropylene syringes.
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Affiliation(s)
- David Palmero
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland
| | - Emilienne Chavan
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland
| | | | | | - Ermindo R Di Paolo
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland
| | - André Pannatier
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland
| | - Hugues Henry
- Department of Biomedicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Farshid Sadeghipour
- Department of Pharmacy, Lausanne University Hospital, Lausanne, Switzerland.,School of Pharmaceutical Sciences, Geneva and Lausanne Universities, Geneva, Switzerland
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2
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DiBlasi RM, Crotwell DN, Shen S, Zheng J, Fink JB, Yung D. Iloprost drug delivery during infant conventional and high-frequency oscillatory ventilation. Pulm Circ 2016; 6:63-9. [PMID: 27162615 PMCID: PMC4860545 DOI: 10.1086/685080] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Iloprost is a selective pulmonary vasodilator approved for inhalation by the Food and Drug Administration. Iloprost has been increasingly used in the management of critically ill neonates with hypoxic lung disease. This in vitro study was designed to test the hypothesis that aerosol drug delivery could be effectively administered to infants with both conventional ventilation and high-frequency oscillatory ventilation (HFOV). A neonatal test lung model configured with newborn lung mechanics was ventilated with a conventional ventilator and an HFOV with standard settings. A vibrating-mesh nebulizer was placed (1) proximal to the patient airway in the inspiratory limb between the humidifier probe and patient wye (conventional) as well as between the vent circuit and the endotracheal tube (ETT) for HFOV and (2) between the ventilator and humidifier (distal). Iloprost was nebulized in three separate runs using three new nebulizers in each of the circuit locations. A collecting filter was placed at the distal end of the ETT for each trial. Iloprost was quantified using high-performance liquid chromatography. The percentage of nominal dose delivered was greater with the nebulizer placed proximal to the airway for conventional ventilation (10.74% ± 2%) and HFOV (29% ± 2%) than with it placed in the distal position (2.96% ± 0.2% vs. 0.96% ± 0.8%, respectively; P < 0.05). Drug delivery in proximal position was nearly threefold greater during HFOV than during conventional ventilation. In conclusion, iloprost drug delivery was best achieved when the nebulizer was placed proximal to the patient airway during neonatal mechanical ventilation. Drug delivery appears to be more efficient during HFOV than during conventional ventilation.
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Affiliation(s)
- Robert M DiBlasi
- Respiratory Therapy Department, Seattle Children's Hospital, Seattle, Washington, USA; Seattle Children's Hospital Research Institute, Seattle, Washington, USA
| | - Dave N Crotwell
- Respiratory Therapy Department, Seattle Children's Hospital, Seattle, Washington, USA
| | - Shuijie Shen
- Seattle Children's Hospital Research Institute, Seattle, Washington, USA
| | - Jiang Zheng
- Seattle Children's Hospital Research Institute, Seattle, Washington, USA
| | | | - Delphine Yung
- Department of Cardiology, Seattle Children's Hospital, Seattle, Washington, USA
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3
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Carvalho TC, McConville JT. The function and performance of aqueous aerosol devices for inhalation therapy. ACTA ACUST UNITED AC 2016; 68:556-78. [PMID: 27061412 DOI: 10.1111/jphp.12541] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 02/05/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES In this review paper, we explore the interaction between the functioning mechanism of different nebulizers and the physicochemical properties of the formulations for several types of devices, namely jet, ultrasonic and vibrating-mesh nebulizers; colliding and extruded jets; electrohydrodynamic mechanism; surface acoustic wave microfluidic atomization; and capillary aerosol generation. KEY FINDINGS Nebulization is the transformation of bulk liquids into droplets. For inhalation therapy, nebulizers are widely used to aerosolize aqueous systems, such as solutions and suspensions. The interaction between the functioning mechanism of different nebulizers and the physicochemical properties of the formulations plays a significant role in the performance of aerosol generation appropriate for pulmonary delivery. Certain types of nebulizers have consistently presented temperature increase during the nebulization event. Therefore, careful consideration should be given when evaluating thermo-labile drugs, such as protein therapeutics. We also present the general approaches for characterization of nebulizer formulations. SUMMARY In conclusion, the interplay between the dosage form (i.e. aqueous systems) and the specific type of device for aerosol generation determines the effectiveness of drug delivery in nebulization therapies, thus requiring extensive understanding and characterization.
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Affiliation(s)
- Thiago C Carvalho
- Bristol-Myers Squibb, Drug Product Science & Technology, New Brunswick, NJ, USA
| | - Jason T McConville
- Department of Pharmaceutical Sciences, University of New Mexico, Albuquerque, NM, USA
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4
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Cheng C, Du L, Yu J, Lu Q, He Y, Ran T. Ciprofloxacin plus erythromycin or ambroxol ameliorates endotracheal tube-associated Pseudomonas aeruginosa biofilms in a rat model. Pathol Res Pract 2015; 211:982-8. [PMID: 26601615 DOI: 10.1016/j.prp.2015.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 09/27/2015] [Accepted: 10/02/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Pseudomonas aeruginosa is a multi-drug resistant bacterium, with its biofilm-growing mucoid (alginate-producing) strains being particularly resistant. As atomized drug administration is a common practice in pediatric patients, we compared the effect of inhalational therapy with erythromycin plus ciprofloxacin, with that of ambroxol plus ciprofloxacin, against biofilm producing strains of P. aeruginosa. RESULTS Both combined treatment regimens were associated with a significant reduction in bacterial counts in endotracheal (ET) tubes and lungs, as compared to that observed with ambroxol and erythromycin monotherapies (P<0.05). Ciprofloxacin plus ambroxol appeared to have a higher efficacy than ciprofloxacin plus erythromycin, both in lowering bacterial counts (P<0.05) and in disrupting the structural integrity of biofilm. Histopathological changes in the lungs were milder in the two combined treatment groups, as compared to that in groups treated with single drugs. CONCLUSION Erythromycin or ambroxol in combination with ciprofloxacin could eliminate P. aeruginosa biofilms. When combined with ciprofloxacin, ambroxol outperformed erythromycin in eradicating P. aeruginosa biofilm.
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Affiliation(s)
- Chen Cheng
- Department of Neonatology, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Lizhong Du
- The Children's Hospital, Zhejiang University School of Medicine, China
| | - Jialin Yu
- Department of Neonatology, Children's Hospital, Chongqing Medical University, Chongqing, China.
| | - Qi Lu
- Department of Neonatology, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Yu He
- Department of Neonatology, Children's Hospital, Chongqing Medical University, Chongqing, China
| | - Tao Ran
- Department of Neonatology, Children's Hospital, Chongqing Medical University, Chongqing, China
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5
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Linakis MW, Roberts JK, Lala AC, Spigarelli MG, Medlicott NJ, Reith DM, Ward RM, Sherwin CMT. Challenges Associated with Route of Administration in Neonatal Drug Delivery. Clin Pharmacokinet 2015; 55:185-96. [DOI: 10.1007/s40262-015-0313-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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6
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Sood BG, Keszler M, Garg M, Klein JM, Ohls R, Ambalavanan N, Cotten CM, Malian M, Sanchez PJ, Lakshminrusimha S, Nelin LD, Van Meurs KP, Bara R, Saha S, Das A, Wallace D, Higgins RD, Shankaran S. Inhaled PGE1 in neonates with hypoxemic respiratory failure: two pilot feasibility randomized clinical trials. Trials 2014; 15:486. [PMID: 25496504 PMCID: PMC4414424 DOI: 10.1186/1745-6215-15-486] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 11/27/2014] [Indexed: 01/22/2023] Open
Abstract
Background Inhaled nitric oxide (INO), a selective pulmonary vasodilator, has revolutionized the treatment of neonatal hypoxemic respiratory failure (NHRF). However, there is lack of sustained improvement in 30 to 46% of infants. Aerosolized prostaglandins I2 (PGI2) and E1 (PGE1) have been reported to be effective selective pulmonary vasodilators. The objective of this study was to evaluate the feasibility of a randomized controlled trial (RCT) of inhaled PGE1 (IPGE1) in NHRF. Methods Two pilot multicenter phase II RCTs are included in this report. In the first pilot, late preterm and term neonates with NHRF, who had an oxygenation index (OI) of ≥15 and <25 on two arterial blood gases and had not previously received INO, were randomly assigned to receive two doses of IPGE1 (300 and 150 ng/kg/min) or placebo. The primary outcome was the enrollment of 50 infants in six to nine months at 10 sites. The first pilot was halted after four months for failure to enroll a single infant. The most common cause for non-enrollment was prior initiation of INO. In a re-designed second pilot, co-administration of IPGE1 and INO was permitted. Infants with suboptimal response to INO received either aerosolized saline or IPGE1 at a low (150 ng/kg/min) or high dose (300 ng/kg/min) for a maximum duration of 72 hours. The primary outcome was the recruitment of an adequate number of patients (n = 50) in a nine-month-period, with fewer than 20% protocol violations. Results No infants were enrolled in the first pilot. Seven patients were enrolled in the second pilot; three in the control, two in the low-dose IPGE1, and two in the high-dose IPGE1 groups. The study was halted for recruitment futility after approximately six months as enrollment targets were not met. No serious adverse events, one minor protocol deviation and one pharmacy protocol violation were reported. Conclusions These two pilot RCTs failed to recruit adequate eligible newborns with NHRF. Complex management RCTs of novel therapies for persistent pulmonary hypertension of the newborn (PPHN) may require novel study designs and a longer period of time from study approval to commencement of enrollment. Trial registration: ClinicalTrials.gov Pilot one: NCT number: 00598429 registered on 10 January 2008. Last updated: 3 February 2011. Pilot two: NCT number: 01467076 17 October 2011. Last updated: 13 February 2013. Electronic supplementary material The online version of this article (doi:10.1186/1745-6215-15-486) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Beena G Sood
- Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien Blvd., 4H42, Detroit, MI, 48201, USA.
| | - Martin Keszler
- Department of Pediatrics, Women and Infants Hospital, Brown University, 101 Dudley Street, Providence, RI, 0290, USA.
| | - Meena Garg
- Department of Pediatrics, University of California, 10833 Le Conte Avenue, Room B2-375 MDCC, Los Angeles, CA, 90095, USA.
| | - Jonathan M Klein
- Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA.
| | - Robin Ohls
- MSC10 5590 1, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131-0001, USA.
| | - Namasivayam Ambalavanan
- Division of Neonatology, University of Alabama at Birmingham, 176F Suite 9380 619 South 19th St, Birmingham, AL, 35249-7335, UK.
| | - C Michael Cotten
- Department of Pediatrics, Duke University, 2424 Erwin Road Suite 504, Durham, NC, 27705, USA.
| | - Monica Malian
- Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien Blvd., 4H42, Detroit, MI, 48201, USA.
| | - Pablo J Sanchez
- Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
| | - Satyan Lakshminrusimha
- Department of Pediatrics, University of Buffalo, 219 Bryant Street, Buffalo, NY, 14222, USA.
| | - Leif D Nelin
- Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, 700 Children's Drive, W203, Columbus, OH, 43205, USA.
| | - Krisa P Van Meurs
- Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine and Lucile Packard Children's Hospital, 750 Welch Road, Suite 315, Palo Alto, CA, 94304, USA.
| | - Rebecca Bara
- Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien Blvd., 4H42, Detroit, MI, 48201, USA.
| | - Shampa Saha
- Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, NC, USA.
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, 6110 Executive Blvd., Suite 902, Rockville, MD, 20852-3903, USA.
| | - Dennis Wallace
- Social, Statistical and Environmental Sciences Unit, RTI International, 6110 Executive Blvd., Suite 902, Rockville, MD, 20852-3903, USA.
| | - Rosemary D Higgins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rm 4B03, 6100 Executive Blvd., MSC 7510, Bethesda, MD, 20892-7510, USA.
| | - Seetha Shankaran
- Department of Pediatrics, Children's Hospital of Michigan, 3901 Beaubien Blvd., 4H42, Detroit, MI, 48201, USA.
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Zhang N, Zhang Q, Chu T, Jin H, Ma WC, Fu HM, Yu XY, Li Q, Wang ZZ, Mao SJ. Formulation optimization of prostaglandin E 1-loaded lipid emulsion: Enhanced stability and reduced biodegradation. Pharm Dev Technol 2013; 18:804-12. [DOI: 10.3109/10837450.2012.659255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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8
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Sood B, Chen X, Dawe E, Malian M, Maddipati K. Tissue Distribution, Metabolism and Excretion of PGE1 Following Prolonged High-Dose Inhalation in Neonatal Pigs. INT J PHARMACOL 2010. [DOI: 10.3923/ijp.2010.224.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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9
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SOOD BG, SHEN Y, LATIF Z, GALLI B, DAWE EJ, HAACKE EM. Effective aerosol delivery during high-frequency ventilation in neonatal pigs. Respirology 2010; 15:551-5. [DOI: 10.1111/j.1440-1843.2010.01714.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Sood BG, Chintala K, Wykes S, Gurczynski J, Chen X, Rabah R. Effect of aerosolized PGE(1) on the ductus arteriosus of neonatal swine. Prostaglandins Other Lipid Mediat 2009; 90:49-54. [PMID: 19686864 DOI: 10.1016/j.prostaglandins.2009.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 08/07/2009] [Accepted: 08/07/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Inhaled PGE(1) (IPGE(1)) is a potential pulmonary vasodilator in neonatal respiratory failure. However, its effect on the patency of the ductus arteriosus (DA) has not been described. OBJECTIVE To investigate the effect of IPGE(1) on the DA in healthy piglets. DESIGN/METHODS IPGE(1) (1200ng/kg/min) [Study] or nebulized saline [Control] was administered using a jet nebulizer. Transthoracic echocardiography (TTE) was performed prior to (T0) and after 24h of aerosol therapy (T24). The DA was also evaluated histomorphologically at autopsy. RESULTS Fifteen piglets, 1-9 days old (study=9; control=6), were evaluated for DA patency. Study piglets received IPGE(1) for 12-24h. TTE was performed on 12 piglets at T0. Nine animals showed no ductal flow and 3 (1 study, 2 control) had a small DA. TTE at T24 in 5 animals showed no change in DA. At autopsy, the ductal diameter and histologic maturity stage were comparable in study and control animals. CONCLUSIONS High dose IPGE(1) given for 12-24h does not exert significant effect on the DA of healthy term piglets as evaluated by echocardiography and histomorphology. We conclude that ductal patency in neonates is influenced not only by prostaglandins but also by factors like hypoxemia, prematurity, and heart disease.
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Affiliation(s)
- Beena G Sood
- Division of Neonatal-Perinatal Medicine, Wayne State University and Children's Hospital of Michigan, Detroit, MI 48201, United States.
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Sood BG, Shen Y, Latif Z, Chen X, Sharp J, Neelavalli J, Joshi A, Slovis TL, Haacke EM. Aerosol delivery in ventilated newborn pigs: an MRI evaluation. Pediatr Res 2008; 64:159-64. [PMID: 18391839 DOI: 10.1203/pdr.0b013e3181761841] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulmonary deposition of inhaled drugs in ventilated neonates has not been studied in vivo. The objective of this study was to evaluate pulmonary delivery of gadopentetate dimeglumine (Gd-DTPA) following nebulization in ventilated piglets using magnetic resonance imaging. Seven ventilated piglets (5 +/- 2 d old, weight 1.8 +/- 0.5 kg) were scanned in the Bruker/Siemens 4T magnetic resonance scanner using T1 weighted spin-echo sequence. Aerosols of Gd-DTPA were generated continuously using the MiniHeart jet nebulizer. Breath-hold coronal images were obtained before and every 10 min during aerosolized Gd-DTPA for 90 min. Signal intensity (SI) changes over the lungs, kidneys, liver, skeletal muscle, and heart were evaluated. A significant increase in SI was observed in the lungs, kidney, and liver at 10, 20, and 40 min respectively after start of aerosol. At the end of 90 min, the SI increased by 95%, 101%, and 426% over the right lung, left lung, and kidney, respectively. A much smaller increase in SI was observed over the liver. In conclusion, we have demonstrated effective pulmonary aerosol delivery within 10 min of contrast nebulization in ventilated piglets. Contrast visualization in the kidneys within 20 min of aerosol initiation reflects alveolar absorption, glomerular filtration and renal concentration.
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Affiliation(s)
- Beena G Sood
- Department of Pediatrics, Children's Hospital of Michigan, 4H42, Detroit, MI 48201, USA.
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Toxicity of prolonged high dose inhaled PGE1 in ventilated neonatal pigs. Pulm Pharmacol Ther 2008; 21:565-72. [PMID: 18343700 DOI: 10.1016/j.pupt.2008.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 01/14/2008] [Accepted: 01/22/2008] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the toxicity of inhaled PGE1 (IPGE1) in healthy ventilated piglets. METHODS Mechanically ventilated anesthetized piglets received either high dose IPGE1 (IPGE1 group) or nebulized saline (control group) continuously for 24h. Cardio-respiratory parameters, complete blood counts and serum electrolytes were monitored. Lung histology was evaluated by a masked pathologist for the severity (minimal, moderate, and severe) and extent (focal, multifocal, and diffuse) of histologic injury. RESULTS Ten neonatal pigs were instrumented. Four received nebulized saline and six received high dose IPGE1. There was no evidence of adverse cardio-respiratory effects, bronchial irritation or hypernatremia related to IPGE1. Diffuse/multifocal alveolar edema and focal polymorphonuclear infiltration was observed in both the control and IPGE1 groups suggesting that alveolar alterations may be secondary to effects of mechanical ventilation. The most distinct histomorphological abnormalities observed in the IPGE1 animals were focal ulceration, flattening of the bronchial epithelium and loss of cilia of moderate to severe degree in the trachea and bronchi. CONCLUSION In healthy piglets, inhalation of high dose IPGE1 was not associated with adverse cardiorespiratory effects, bronchial irritation, or hypernatremia and produced minimal signs of pulmonary toxicity even after 24h. Prolonged inhalation of high dose PGE1 therefore appears safe in newborn piglets.
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