Standardizing Prostaglandin Initiation in Prenatally Diagnosed Ductal-Dependent Neonates; A Quality Initiative.

Autor: Haughey BS; Department of Pediatrics (Cardiology), University of Virginia, 1204 W. Main St, Charlottesville, VA, 22903, USA., Elliott MR; Department of Pediatrics (Neonatology), University of Virginia, Charlottesville, VA, USA., Wiggin JY; Department of Pediatrics (Neonatology), University of Virginia, Charlottesville, VA, USA., Conaway MR; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA., White SC; Department of Pediatrics (Cardiology), University of Virginia, 1204 W. Main St, Charlottesville, VA, 22903, USA., Swanson JR; Department of Pediatrics (Neonatology), University of Virginia, Charlottesville, VA, USA., Dean PN; Department of Pediatrics (Cardiology), University of Virginia, 1204 W. Main St, Charlottesville, VA, 22903, USA. pnd8j@virginia.edu.
Jazyk: angličtina
Zdroj: Pediatric cardiology [Pediatr Cardiol] 2023 Aug; Vol. 44 (6), pp. 1327-1332. Date of Electronic Publication: 2022 Dec 20.
DOI: 10.1007/s00246-022-03075-9
Abstrakt: 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.
(© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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