Early discontinuation of intravenous prostaglandin E1 after balloon atrial septostomy is associated with an increased risk of rebound hypoxemia

E Finan; W Mak; Z Bismilla; P J McNamara

doi:10.1038/jp.2008.11

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Early discontinuation of intravenous prostaglandin E1 after balloon atrial septostomy is associated with an increased risk of rebound hypoxemia

Journal article

Peer reviewed

Early discontinuation of intravenous prostaglandin E1 after balloon atrial septostomy is associated with an increased risk of rebound hypoxemia

E Finan, W Mak, Z Bismilla and P J McNamara

Journal of perinatology, Vol.28(5), pp.341-346

05/2008

DOI: 10.1038/jp.2008.11

PMID: 18337745

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Abstract

A comparison of the effects of early (<2 h) and late (>or=2 h) discontinuation of prostaglandin E1 (PGE1), on systemic oxygenation following a successful balloon atrial septostomy (BAS), in neonates with confirmed diagnosis of d-transposition of the great arteries (d-TGA). Neonates with a postnatal diagnosis of d-TGA who were admitted to a quaternary neonatal intensive care unit between January 1999 and December 2004 were identified from the local database. The effects of time of discontinuation of PGE1 on oxygen saturations, oxygen requirement, need for reinstitution of prostaglandin infusion and postoperative stability were analyzed. Sixty neonates with a diagnosis of d-TGA were identified, 45 of whom had a BAS performed. Of these, 25 cases had early (<2 h) discontinuation of PGE1 whereas in the remaining 20 discontinuation was late (>or=2 h). PGE1 infusion was recommenced in 20 neonates (20/45 (44%)) after a successful BAS due to rebound hypoxemia. Of these, there was a threefold increase in the need for reinstitution of prostaglandin in the early compared to late discontinuation group (16/25 (64%) vs 4/20 (20%), P<0.006). There was no difference in postoperative cardiorespiratory stability. Early discontinuation of intravenous PGE1 following BAS was associated with an increased risk of rebound hypoxemia, necessitating the recommencement of PGE1. We speculate the rapid improvement in oxygenation on reinstitution of PGE1 is secondary to pulmonary vasodilation and improved pulmonary blood flow. We propose a more cautious and graded approach to discontinuation of PGE1 based on illness severity and the magnitude and duration of hypoxemia at presentation.

Recurrence

Prognosis

Humans

Male

Heart Atria - diagnostic imaging

Alprostadil - administration & dosage

Transposition of Great Vessels - diagnostic imaging

Intensive Care Units, Neonatal

Female

Retrospective Studies

Heart Septum - surgery

Hypoxia - diagnostic imaging

Infant, Newborn

Heart Septum - diagnostic imaging

Echocardiography

Catheterization

Drug Administration Schedule

Heart Atria - surgery

Oxygen - blood

Hypoxia - blood

Hypoxia - surgery

Transposition of Great Vessels - blood

Transposition of Great Vessels - therapy

Infusions, Intravenous

Ontario

Cohort Studies

Details

Title: Subtitle: Early discontinuation of intravenous prostaglandin E1 after balloon atrial septostomy is associated with an increased risk of rebound hypoxemia
Creators: E Finan - Department of Paediatrics, University of Toronto, and Physiology and Experimental Medicine Program, Acute Care Transport Services, The Hospital for Sick Children, Toronto, Canada
W Mak
Z Bismilla
P J McNamara
Resource Type: Journal article
Publication Details: Journal of perinatology, Vol.28(5), pp.341-346
DOI: 10.1038/jp.2008.11
PMID: 18337745
ISSN: 0743-8346
eISSN: 1476-5543
Language: English
Date published: 05/2008
Academic Unit: Stead Family Department of Pediatrics; Neonatology; Internal Medicine
Record Identifier: 9984093486502771

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