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Use of prostaglandin E1 to treat pulmonary hypertension in congenital diaphragmatic hernia
- Source :
- Journal of Pediatric Surgery. 54:55-59
- Publication Year :
- 2019
- Publisher :
- Elsevier BV, 2019.
-
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 ± 2 days. BNP levels declined after 1.4 ± 0.2 days of treatment and again after 5.2 ± 0.6 days. After 6 ± 0.8 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.
- Subjects :
- Male
medicine.medical_specialty
medicine.drug_class
Hypertension, Pulmonary
Vasodilator Agents
Hypoxemia
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
030225 pediatrics
Internal medicine
Ductus arteriosus
Natriuretic Peptide, Brain
medicine
Natriuretic peptide
Humans
Registries
cardiovascular diseases
Alprostadil
Prostaglandin E1
Retrospective Studies
Philadelphia
business.industry
Infant, Newborn
Congenital diaphragmatic hernia
Metabolic acidosis
General Medicine
medicine.disease
Pulmonary hypertension
Treatment Outcome
medicine.anatomical_structure
chemistry
Echocardiography
Ventricle
030220 oncology & carcinogenesis
Pediatrics, Perinatology and Child Health
Cardiology
Female
Surgery
medicine.symptom
Hernias, Diaphragmatic, Congenital
business
Subjects
Details
- ISSN :
- 00223468
- Volume :
- 54
- Database :
- OpenAIRE
- Journal :
- Journal of Pediatric Surgery
- Accession number :
- edsair.doi.dedup.....b23658d1338f71996efd9fbff407f165