Vari Daniel, Xiao Wendi, Behere Shashank, Spurrier Ellen, Tsuda Takeshi, Baffa Jeanne M
Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Department of Biostatistics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
Cardiol Young. 2021 Jan;31(1):63-70. doi: 10.1017/S1047951120003297. Epub 2020 Nov 3.
Prostaglandin E1 is used to maintain ductal patency in critical congenital heart disease (CHD). The standard starting dose of prostaglandin E1 is 0.05 µg/kg/minute. Lower doses are frequently used, but the efficacy and safety of a low-dose regimen of prostaglandin E1 has not been established.
We investigated neonates with critical CHD who were started on prostaglandin E1 at 0.01 µg/kg/minute. We reviewed 154 consecutive patients who were separated into three anatomical groups: obstruction to systemic circulation, obstruction to pulmonary circulation, and inadequate mixing (d-transposition of the great arteries). Treatment failure rates and two commonly reported side effects, respiratory depression and seizure, were studied.
A total of 26 patients (17%) required a dose increase in prostaglandin E1. Patients with pulmonary obstruction were more likely to require higher doses than patients with systemic obstruction (15/49, 31% versus 9/88, 10%, p = 0.003). Twenty-eight per cent of patients developed respiratory depression and 8% of patients needed mechanical ventilation. Prematurity (<37 week gestation) was the primary risk factor for respiratory depression. No patient required dose escalation or tracheal intubation while on transport. No patient had a seizure attributed to prostaglandin E1.
Prostaglandin E1 at an initial and maintenance dose of 0.01 µg/kg/minute was sufficient to maintain ductal patency in 83% of our cohort. The incidence of respiratory depression requiring mechanical ventilation was low and was mostly seen in premature infants. Starting low-dose prostaglandin E1 at 0.01 µg/kg/minute is a safe and effective therapy for critical CHD.
前列腺素E1用于维持重症先天性心脏病（CHD）患儿的动脉导管通畅。前列腺素E1的标准起始剂量为0.05µg/（kg·分钟）。低剂量用药也较为常用，但其疗效及安全性尚未得到证实。
我们对以0.01µg/（kg·分钟）的剂量开始使用前列腺素E1治疗的重症CHD新生儿进行了研究。我们回顾了154例连续患者，根据解剖结构分为三组：体循环梗阻、肺循环梗阻和混合不足（大动脉d型转位）。研究了治疗失败率以及两种常见的副作用，即呼吸抑制和癫痫发作。
共有26例患者（17%）需要增加前列腺素E1的剂量。与体循环梗阻患者相比，肺循环梗阻患者更需要增加剂量（15/49，31%对9/88，10%，p = 0.003）。28%的患者出现呼吸抑制，8%的患者需要机械通气。早产（孕周<37周）是呼吸抑制的主要危险因素。在转运过程中，没有患者需要增加剂量或气管插管。没有患者出现与前列腺素E1相关的癫痫发作。
初始及维持剂量为0.01µg/（kg·分钟）的前列腺素E1足以使83%的队列患者维持动脉导管通畅。需要机械通气的呼吸抑制发生率较低，且多见于早产儿。以0.01µg/（kg·分钟）开始使用低剂量前列腺素E1治疗重症CHD是一种安全有效的疗法。
