Prolonged treatment with prostaglandin in an infant born with extremely low weight

Efficacy of very low-dose prostaglandin E1 in duct-dependent congenital heart disease

AIM

The present study aims to define the lowest effective prostaglandin E1 dose in patients with inadequacy of pulmonary blood flow and/or intracardiac blood mixing and those with inadequate systemic blood flow.

METHODS

Patients with inadequacy of both pulmonary blood flow and/or blood mixing (Group 1) and those with inadequate systemic blood flow (Group 2) were retrospectively evaluated in two separate groups with regard to the prostaglandin E1 starting dose given in the referring facility, the lowest and the highest dose administered in our centre, treatment duration, adverse effects, and administered treatment.

RESULTS

No difference between the groups could be detected with respect to sex or birth weight (p=0.95 and 0.42, respectively). Group 1 and Group 2 were statistically similar in aspect of prostaglandin treatment duration (9.73±0.81 days versus 11.6±1.05 days, p=0.064). When compared with Group 2, the initial, maintenance and lowest efficient doses of prostaglandin E1 treatment were significantly lower and the titrated dose of prostaglandin E1 was significantly higher in Group 1 (p=0.001 for each).

CONCLUSION

Our findings indicate that the infusion of prostaglandin at a very low dose (0.003-0.005 mcg/kg/minute) is sufficient to maintain the patency of the ductus arteriosus. A higher dose of prostaglandin E1 may be necessary in patients with inadequate systemic blood flow.

Prostaglandin therapy for ductal patency: how long is too long?

The management of neonates born with duct-dependent congenital heart defects in association with prematurity or low birth weight is challenging. We describe two preterm and low birth weight infants with duct-dependent congenital heart disease where cardiac surgery was successfully delayed by maintaining ductal patency using a prolonged prostaglandin infusion. This allowed time for growth and maturation and therefore reduced the risks associated with surgery and cardiopulmonary bypass.

CONCLUSION

Maintenance of ductal patency by a prolonged prostaglandin infusion in low birth weight or preterm infants with duct-dependent congenital heart disease is a viable option that allows cardiac surgery to be delayed whilst awaiting further growth and development.