Evaluation of Oral Prostaglandin E1 in Management of Ductus Dependent Congenital Heart Disease

Year 2012, Volume: 37 Issue: 3, 150 - 156, 01.09.2012

Hüseyin Altunhan Ali Annagür Fatih Şap Murat Konak Sabahattin Ertuğrul Sevim Karaaslan Rahmi Örs

Abstract

Purpose: Intravenous prostaglandin E1 (PGE1) infusion is a treatment which has been proven to be effective in ductus dependent congenital heart disease. However, PGE1 is very expensive, needed continuous infusion and its supply is difficult by every center. When its long term use is necessary, these problems become more important. The aim of this study was to show whether oral PGE1could keep the ductus open or not till the supply of intravenous PGE1. Method: Ten patients, who were admitted to newborn intensive care unit with the diagnosis of ductus dependent congenital heart disease and received oral PGE1 till the supply of intravenous PGE1, were evaluated. The PO2 with the arterial blood gas analysis and SO2 levels with pulse oxymeter at skin were recorded before and after the administration of oral and intravenous PGE1. Results: The mean oral PGE1 initiation age was 5.5 hours (0.5-25), and mean administration period was 28 hours (18-46). It was observed that the PO2 and SO2 levels of patients measured 2 hours after the initiation of oral PGE1 were significantly increased compared to the levels before initiation of PGE1. The improvement in PO2 and SO2 levels continued till the initiation of intravenous PGE1. It was also observed that the PO2 and SO2 levels of patients measured 2 hours after the initiation of intravenous PGE1 were slightly increased compared to levels before initiation of intravenous PGE1. Conclusion: Although intravenous PGE1 is more effective than oral PGE1 in short term usage, oral PGE1 is also sufficiently effective in keeping the dustus open. For this reason until the intravenous PGE1 is supplied oral PGE1 may be used as an alternative treatment choice. We think that in long term use oral PGE1, which is cheaper and easy to use, could be used instead of intravenous PGE1 without need of admission to hospital and opening intravenous line. However for this further studies are needed to confirm this assumption.

Keywords

Congenital heart disease, ductus arteriosus, newborn, Prostaglandin, PGE1

Duktus Bağımlı Konjenital Kalp Hastalıklarında Oral Prostaglandin E1 Tedavisinin Değerlendirilmesi

Abstract

Amaç: İntravenöz prostaglandin E1 (PGE1) infüzyonu duktus bağımlı konjenital kalp hastalarında etkisi kanıtlanmış bir ilaçtır. Ancak intravenöz PGE1 oldukça pahallı, sürekli intravenöz infüzyon gerektiren ve her merkezce temini zor bir ilaçtır. Uzun süre kullanılması gerektiğinde bu sorunlar daha önemli hale gelmektedir. Bu çalışmada Oral PGE1"in intravenöz PGE1 temin edilinceye kadar duktusun açık kalmasını sağlayıp sağlamadığını göstermek amaçlanmıştır. Yöntem: Yenidoğan yoğun bakım ünitesine duktus bağımlı konjenital kalp hastalığı tanısıyla yatırılıp intravenöz PGE1 temin edilinceye kadar oral PGE1 verilen 10 hasta retrospektif olarak incelendi. Hastaların oral PGE1 ve intravenöz PGE1 başlanmadan önce ve sonra arteryal kan gazında pO2 ve ciltten bakılan sO2 değerleri kaydedildi. Bulgular: Oral PGE1 tedavisine ortalama başlama yaşı 5.5 saat (0.5-25), verilme süresi 28 saat (18-46) idi. Hastaların oral PGE1 başlandıktan 2 saat sonra alınan pO2 ve sO2 değerlerinin başlanmadan önceki değerlerine göre istatistiksel olarak anlamlı bir şekilde arttığı gözlendi. PO2 ve SO2 düzeyindeki düzelme intravenöz PGE1 başlanıncaya kadar devam etti. İntravenöz PGE1 başlandıktan 2 saat sonra bakılan PO2 ve SO2 değerlerinin intravenöz PGE1 başlanmadan önce bakılan değerlerine göre bir miktar daha artış gösterdiği gözlendi. Sonuç: Kısa süreli kullanımda intravenöz PGE1 oral PGE1"den daha etkili olsa da oral PGE1"de duktusun açık kalmasında yeterince etkilidir. Bu nedenle intravenöz PGE1 temin edilinceye kadar oral PGE1 alternatif bir seçenek olarak kullanılabilir. Uzun süreli kullanımda ise damar yoluna ve hastanede yatışa gerek duyulmadan, kullanımı kolay ve oldukça ucuz olan oral PGE1"in intravenöz PGE1 yerine kullanılabileceğini düşünüyoruz. Ancak bunun için daha ileri çalışmalara ihtiyaç vardır.

Keywords

Prostaglandin, PGE1, ductus arteriozus, yenidoğan, konjenital kalp hastalığı

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