Use of prostaglandin E1 to treat pulmonary hypertension in congenital diaphragmatic hernia
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In brief
In brief
Retrospective study of 57 CDH neonates demonstrates that prostaglandin E1 therapy effectively reduces severe pulmonary hypertension by maintaining ductal patency and unloading the right ventricle. Treatment showed significant improvements in BNP levels and echocardiographic parameters without causing postductal hypoxemia or systemic hypoperfusion.
Written by the GCMD Library team from the article.
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.