Department of Pediatrics (Cardiology), University of Virginia, 1204 W. Main St, Charlottesville, VA, 22903, USA.
Department of Pediatrics (Neonatology), University of Virginia, Charlottesville, VA, USA.
Pediatr Cardiol. 2023 Aug;44(6):1327-1332. doi: 10.1007/s00246-022-03075-9. Epub 2022 Dec 20.
Prostaglandin E1 (PGE) is used in patients with ductal-dependent congenital heart disease (CHD). Side effects of apnea and fever are often dose dependent and occur within 48 h after initiation. We initiated a standardized approach to PGE initiation after our institution recognized a high incidence of side effects and a wide variety of starting doses of PGE. Neonates with prenatally diagnosed ductal-dependent CHD were identified, started on a standardized protocol that started PGE at 0.01 mcg/kg/min, and evaluated for PGE related side effects. Compliance, outcomes and dose adjustments during the first 48 h post-PGE initiation were evaluated. Fifty patients were identified (25 pre-intervention; 25 post-intervention). After intervention, compliance with the protocol was 96%, and apnea or fever occurred in 28% (compared to 63% pre-intervention, p = 0.015). Dose adjustments (either increase or decrease) prior to cardiac surgery were similar in both cohorts (60%, 52%, p = 0.569). There were no mortalities or emergent procedures performed due to ductus arteriosus closure. Standardizing a protocol for initiating PGE in prenatally diagnosed ductal-dependent CHD was successful and reduced the incidence of apnea, fever, and sepsis evaluations. A starting dose of 0.01 mcg/kg/min did not cause increased adverse effects.
前列腺素 E1（PGE）用于患有导管依赖性先天性心脏病（CHD）的患者。呼吸暂停和发热的副作用通常与剂量有关，并在开始后 48 小时内发生。在我们的机构认识到副作用发生率高且 PGE 的起始剂量多种多样后，我们开始采用标准化方法来启动 PGE。通过识别出患有产前诊断的导管依赖性 CHD 的新生儿，开始使用标准化方案，以 0.01 mcg/kg/min 的剂量开始 PGE，并评估 PGE 相关的副作用。评估了 PGE 启动后前 48 小时内的依从性、结局和剂量调整。确定了 50 名患者（干预前 25 名；干预后 25 名）。干预后，该方案的依从性为 96％，呼吸暂停或发热发生在 28％（与干预前的 63％相比，p=0.015）。在心脏手术前，两组的剂量调整（增加或减少）相似（60％，52％，p=0.569）。由于动脉导管关闭，没有发生死亡或紧急手术。为产前诊断的导管依赖性 CHD 制定启动 PGE 的标准化方案是成功的，降低了呼吸暂停、发热和败血症评估的发生率。起始剂量为 0.01 mcg/kg/min 不会增加不良反应。
