Use of prostaglandin E1 to treat pulmonary hypertension in congenital diaphragmatic hernia.

TitleUse of prostaglandin E1 to treat pulmonary hypertension in congenital diaphragmatic hernia.
Publication TypeJournal Article
Year of Publication2019
AuthorsLawrence KM, Berger K, Herkert L, Franciscovich C, O'Dea CLynn H, Waqar LN, Partridge E, Hanna BD, Peranteau WH, Avitabile CM, Hopper RK, Rintoul NE, Hedrick HL
JournalJ Pediatr Surg
Volume54
Issue1
Pagination55-59
Date Published2019 Jan
ISSN1531-5037
KeywordsAlprostadil, Echocardiography, Female, Hernias, Diaphragmatic, Congenital, Humans, Hypertension, Pulmonary, Infant, Newborn, Male, Natriuretic Peptide, Brain, Philadelphia, Registries, Retrospective Studies, Treatment Outcome, Vasodilator Agents
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.

DOI10.1016/j.jpedsurg.2018.10.039
Alternate JournalJ Pediatr Surg
PubMed ID30442461