Neonatology Book

Cardiovascular Medicine

  • Prostaglandin E1

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Prostaglandin E1

Aka: Prostaglandin E1, PGE-1
  1. See Also
    1. Congenital Heart Disease
    2. Ductal Dependent Lesions
  2. Indications
    1. Maintain patency or reopen ductus arteriosus
    2. See Ductal Dependent Lesions
  3. Mechanism
    1. Vasodilation including ductus arteriosus via arterial smooth muscle relaxation
  4. Pharmacokinetics
    1. Onset of effect seen in <30 minutes for cyanotic lesion
    2. Acyanotic lesions may take longer to see effect
  5. Contraindications
    1. Total Anomalous Pulonary Venous Return (TAPVR)
      1. Pulmonary veins attach to vena cava
      2. Prostaglandin worsens TAPVR
  6. Preparation: Method 1
    1. Keep refrigerated
    2. Infusion
      1. Start with "x" mg of Prostaglandin E1
        1. Where "x" = 0.3 x WeightKg
      2. Add enough D5W to Prostaglandin for 50 ml total
    3. At this dilution
      1. Infusion rate of 0.5 ml/min provides 0.05 mcg/kg/min
  7. Preparation: Method 2
    1. Dissolve 500 mcg (1 ampule) of PGE-1 in 100 ml D5W
    2. Creates PGE-1 solution 5 mcg/ml
    3. Infusion rate of 0.01 ml/min provides 0.05 mcg/min
  8. Dose
    1. Start
      1. Infuse 0.01 mcg/kg/min
    2. Titrate to effect
      1. Increase to 0.05 - 0.10 mcg/kg/min as needed
      2. Decrease to 0.025 mcg/kg/min as able as ductus opens
        1. Anticipate Hypotension as circulation re-distributes with increased PDA opening
        2. Monitor Blood Pressure in all 4 limbs to confirm improved ductus flow
  9. Adverse Effects (potentially lethal)
    1. Flushing
    2. Peripheral Edema
    3. Hypotension
    4. Apnea
    5. Hyperpyrexia
    6. Jitteriness
    7. Diarrhea
    8. Hypoglycemia
    9. Hypocalcemia
    10. Renal Failure
    11. Rhythm disturbance
    12. Coagulopathies
  10. Precautions
    1. Adverse effects are common and potentially lethal (see above)
    2. Prepare before infusing prostaglandins
      1. Apnea
        1. Intubation
      2. Hypotension
        1. Inotropes: Dobutamine (Milrinone)
        2. Pressors: Norepinephrine, Epinephrine, Phenylephrine
          1. Do NOT pressors if ductal dependent systemic circulation (Aortic Coarctation)
          2. Risk of worsening coarctation and Cardiac Arrest
  11. References
    1. Sloas, Checchia and Orman in Majoewsky (2013) EM: Rap 13(9): 8

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