Can prostaglandin E1 dosage adjustment calibrate the ductus arteriosus?

Introduction

Prostaglandin E1 (PGE1) infusion is commonly used to maintain ductus arteriosus (DA) patency in neonates with duct-dependent congenital heart disease or severe pulmonary hypertension. Identifying reliable parameters for calibrating DA patency in response to dosage adjustments is essential. This study investigates whether there is a dose-dependent relationship between PGE1 infusion and the inner diameter of the DA.

Method

A retrospective study was conducted in a level III neonatal intensive care unit from January to December 2022. Newborns who received PGE1 infusion and underwent transthoracic echocardiography before and after any dose adjustment were consecutively included. We assessed DA's inner diameter, mean and end-diastolic velocities in the left pulmonary artery (LPA), and maximal left-to-right transductal velocity.

Results

A total of 19 newborns were included: 12 with duct-dependent congenital heart diseases and 7 with severe pulmonary hypertension. Before dosage adjustment, the median DA inner diameter, mean LPA velocity, end-diastolic LPA velocity, and maximal transductal shunt velocity were 3.0 (2.3–3.6) mm, 0.49 (0.4–0.57) m.s⁻¹, 0.24 (0.19–0.30) m.s⁻¹, and 1.2 (1.0–1.55) m.s⁻¹, respectively. The median reduction in PGE1 dose was −0.0035 (−0.001 to −0.008) μg/kg/min. After dose modification, the median DA inner diameter, mean LPA velocity, end-diastolic LPA velocity, and maximal transductal shunt velocity were 3.0 (2.0–3.9) mm, 0.51 (0.38–0.67) m.s⁻¹, 0.26 (0.20–0.38) m.s⁻¹, and 1.09 (0.8–1.5) m.s⁻¹, respectively. No statistically significant changes were observed across these parameters.

Conclusion

Our findings suggest that changes in echocardiographic hemodynamic parameters of the DA do not correlate with modifications in PGE1 dosage in routine clinical practice. Therefore, no pharmacodynamic model could be predicted based on PGE1 dosage adjustments.