Use of prostaglandin E1 to treat pulmonary hypertension in congenital diaphragmatic hernia.
J Pediatr Surg
; 54(1): 55-59, 2019 Jan.
Article
en En
| MEDLINE
| ID: mdl-30442461
ABSTRACT
BACKGROUND/PURPOSE:
Prostaglandin E1 (PGE) has been used to maintain ductus arteriosus patency and unload the suprasystemic right ventricle (RV) in neonates with congenital diaphragmatic hernia (CDH) and severe pulmonary hypertension (PH). Here we evaluate the PH response in neonates with CDH and severe PH treated with PGE.METHODS:
We performed a retrospective chart review of CDH infants treated at our center between 2011 and 2016. In a subset, PGE was initiated for echocardiographic evidence of severe PH, metabolic acidosis, or hypoxemia. To assess PH response, we evaluated laboratory data, including B-type natriuretic peptide (BNP) and echocardiograms before and after PGE treatment. Categorical and continuous data were analyzed with Fisher's exact tests and Mann-Whitney t-tests, respectively.RESULTS:
Fifty-seven infants were treated with PGE a mean 17⯱â¯2â¯days. BNP levels declined after 1.4⯱â¯0.2â¯days of treatment and again after 5.2⯱â¯0.6â¯days. After 6⯱â¯0.8â¯days of treatment, echocardiographic estimates of severe PH by tricuspid regurgitation jet velocity, ductus arteriosus direction, and ventricular septum position also improved significantly. Treatment was not associated with postductal hypoxemia or systemic hypoperfusion.CONCLUSIONS:
In patients with CDH and severe PH, PGE is well tolerated and associated with improved BNP and echocardiographic indices of PH, suggesting successful unloading of the RV. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE Level III.Palabras clave
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Vasodilatadores
/
Alprostadil
/
Hernias Diafragmáticas Congénitas
/
Hipertensión Pulmonar
Tipo de estudio:
Observational_studies
/
Risk_factors_studies
Límite:
Female
/
Humans
/
Male
/
Newborn
País/Región como asunto:
America do norte
Idioma:
En
Revista:
J Pediatr Surg
Año:
2019
Tipo del documento:
Article
País de afiliación:
Estados Unidos