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Submitted: 30 June 2008
HERDIN Record #: PCHRD070208020702

Echocardiographic assessment of patent ductus arteriosus pre- and post- prostavasin infusion in infants with PDA dependent pulmonary blood flow .

Ma Rowena C. Sanchez,
Jhuliet J. Balderas

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Background ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Studies have already proven the importance of prostaglandin in maintaining patency of ductus arteriosus in infants with ductal-dependent pulmonary or systemic blood flow to maintain hemodynamic stability, while waiting for a palliative or corrective intervention. The problem lies on its availability. The supply is not enough to sustain the continuous infusion needed to maintain the patency of the ductus arteriosus. There are other available prostaglandin E1, like prostavasin 20. However, drug literature of Prostavasin didn't mention its use in infants to maintain ductal patency.1 Thus, this study was locally conducted to determine the efficacy of this alternative drug in maintaining the patency of ductus arteriosus in infants with ductal-dependent pulmonary blood flow.

Methods and Results ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ This is an open non-comparative clinical trial. All infants diagnosed with congenital heart disease ductal-dependent pulmonary blood flow admitted at the Philippine Heart Center who needs continuous prostaglandin infusion to maintain survival prior to a palliative or corrective intervention were included in the study. Prostaglandin E1 (Prostavasin 20) at 20ug/amp was administered through continuous intravenous infusion at .01-0.4ug/kg/min. Infusion rate was gradually titrated until the desired oxygen saturation is achieved. Parameters were recorded before prostavasin infusion, 6 hours and 12 hours post-prostavasin infusion.

A total of 5 neonate who received prostavasin infusion for a PDA dependent pulmonary circulation were enrolled in the study. All were males, with age ranging from 20days (+/- 13.9), weighing 3.2 kg (+/- 0.58) (Table 2). Majority were diagnosed to have a congenital heart disease, d-transpositon of the great artery (CHD d-TGA). The oxygen saturation based on pulse oximetry showed a significant change 24-hours post-prostavasin, from 72.3 percent to 77.8 +/- 11.6 with a P-value of 0.028. The rest of the parameters showed no significant result. Apnea and bradycardia was one of the adverse effects noted.

Conclusion ÃÆ'Æ'Æ’ÃÆ'†â€™ÃÆ'Æ'â€Ã...¡ÃÆ'‚¢ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â‚¬Ã...¡ÃÆ'‚¬ÃÆ'Æ'Æ’ÃÆ'¢â‚¬Ã...¡ÃÆ'Æ'¢ÃÆ'¢â€Ã...¡Ã‚¬ÃÆ'‚ Prostavasin 20 (Alprostadil) given in infants with ductal-dependent pulmonary blood flow on continuous infusion showed a significant increase in oxygen saturation based on pulse oximetry, which is one important indication that it help maintain patency of the ductus. Thus, improving the problem of hypoxemia, keeping the infants hemodynamically stable while awaiting for a palliative or corrective intervention. (Author)

Publication Type
Journal
Publication Sub Type
Journal Article, Original
Title
Philippine Heart Center Journal
Frequency
Quarterly
Publication Date
July-September 2006
Volume
12
Issue
3
Page(s)
19-22

Objectives

1. To determine the effect of prostavasin on the patency of ductus arteriosus pre- and post- prostavasin infusion based on the following:

1.1 Clinical Parameters
1.1.1 Temperature
1.1.2 Capillary refill
1.1.3 Urine output

1.2 Laboratory Parameters
1.2.1 Oxygen saturation
a) pulse oximetry
b) arterial blood gas
1.2.2 2D echocardiography
a) size of ductus arteriosus
b) gradient across the ductus
c) LA: Aorta ratio
d)LVED

1.3 Outcome
1.3.1 Palliative/ Corrective Intervention
1.3.2 Disposition
a) Improved
b) Mortality

1.4 To determine the side effects/adverse effect noted during prostavasin infusion.

LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Library Abstract Print Format (Request Document)