During the infusion of a prostaglandin, the newborn requires careful monitoring of heart rate, blood pressure, respiratory rate, and core body temperature. In the event of complications such as apnoea, profound bradycardia, or severe hypotension, the infusion should be temporarily stopped and the complication dealt with; the infusion should be restarted at a lower dose.
Recurrent or prolonged apnoea may require ventilatory support in order for the prostaglandin infusion to continue. Home Treatment summary Drugs affecting the ductus arteriosus. Closure of the ductus arteriosus In neonates Patent ductus arteriosus is a frequent problem in premature neonates with respiratory distress syndrome.
If drug treatment fails to close the ductus arteriosus, surgery may be indicated. Maintenance of patency In neonates In the newborn with duct-dependent congenital heart disease it is often necessary to maintain the patency of the ductus arteriosus whilst awaiting surgery. Back to top. We found no ongoing or completed randomized studies to include in this review. Currently there is no evidence from randomized trials on prostaglandin PGE1 but information from non-randomized studies is available.
Use of PGE1 in heart lesions, where the ductus arteriosus needs to stay open, is considered standard of care, and it would be perceived as unethical to do randomized studies. The quality of evidence could not be assessed as we found no randomized studies for inclusion in this review. There is insufficient evidence from randomized controlled trials to determine the safety and efficacy of PGE1 in neonates with ductal-dependent cardiac lesions.
Evidence from observational trials have informed clinical practice on the use of PGE, which is now considered the standard of care for ductal-dependent cardiac lesions. It is unlikely that randomized controlled studies will be performed for this indication but comparative efficacy of newer formulations of PGE1, different doses of PGE1 and studies comparing PGE with PDA stents or other measures to keep the ductus open may be ethical and necessary.
Prostaglandin E1 PGE1 is used to keep the ductus arteriosus patent and can be life-saving in neonates with ductal-dependent cardiac lesions. PGE1 is used to promote mixing of pulmonary and systemic blood flow or improve pulmonary or systemic circulations, prior to balloon atrial septostomy or surgery. PGE1 therapy may cause several short-term and long-term adverse effects. The efficacy and safety of PGE1 in neonates with ductal-dependent cardiac lesions has not been systematically reviewed.
We searched the literature in October , using the search strategy recommended by Cochrane Neonatal. We followed the standard Cochrane methods for conducting a systematic review. Two review authors SA and MP independently assessed the titles and abstracts of studies identified by the search strategy to determine eligibility for inclusion. We obtained the full-text version if eligibility could not be done reliably by title and abstract. We resolved any differences by discussion.
Review question: Is keeping the ductus arteriosus open with prostaglandin E1 effective and safe in babies with heart conditions that need an open ductus arteriosus for survival? Background Ductus arteriosus is a blood vessel connection between the large blood vessel supplying blood to the lungs pulmonary artery and to the large blood vessel supplying blood to the body aorta.
Study characteristics: We searched the literature for studies that used chance selection randomization that used PGE1 in neonates born at greater than 34 weeks of gestation to keep the ductus arteriosus open in newborn heart conditions and which reported on effectiveness and safety.
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