ORAL PGE2 IN DUCTUS-DEPENDENT CONGENITAL HEART DEFECTS: CROSS-SECTIONAL EVIDENCE FROM 52 CASES

Abstract

Background: The lack of intravenous prostaglandin (PGE1) is a major obstacle to the treatment of ductus-dependent congenital heart defects (CHD) in settings with limited resources. Even though it's not as often used, oral PGE2 is a good substitute for keeping the ductus arteriosus (DA) open. The purpose of this study is to evaluate the safety and effectiveness of oral PGE2 in newborns and infants with CHD that is dependent on the ductus.

Objectives: to evaluate the safety and efficacy of oral PGE2 in maintaining ductal patency in neonates with ductus-dependent congenital heart defects in a resource-constrained environment.

Study design: A cross-sectional study

Duration and place of study: Department of paeds cardiology MTI, LRH Peshawar from March 2023 to Aug 2023.

Methods: This cross-sectional study was conducted on 52 neonates and infants with ductus-dependent Congenital heart diseases over a 6-month period from March 2023 to August 2023 at Lady reading hospital peshawar. Patients received oral PGE2 in doses ranging from 12-65 µg/kg at intervals of 1-4 hourly. The initial dose was typically 30-45 µg/kg/hour  except for critical cases where a lower dose of 12 µg/kg/hour was initiated. Dosage adjustments were made based on clinical response, with a reduction in frequency after 1-3 weeks and a further reduction to 4-hour intervals after 4 weeks in stable cases. The primary outcomes that were evaluated were the length of ductal patency and variations in arterial oxygen saturation (SaO2). Adverse occurrences, in particular apneic episodes, bradycardia, and gastrointestinal side effects, were considered secondary outcomes.

Results: A total of 52 patients were included, The patients' mean weight was 2.8 kg (range 1.5-4.5 kg) and their mean age was 8 days (range 1-60 days).

PGE2 was taken orally for a period of 5 to 140 days during the course of the treatment. Within 15 to 30 minutes of delivery,

O2 sats steadily rose in all patients, however  O2 sats decreased in 44 patients (2–5 hours) following the PGE2 dosage (from 75% ± 7% to 57% ± 10%), although they quickly recovered to values close to baseline after 30–45 minutes of restarting oral PGE2.

In 38 individuals, prolonged ductal patency allowed for a postponed surgical operation, which improved their overall results and growth. The maximum time a ductus was remained open for was 122 days.

Adverse events were rare; three patients experienced bradycardia, four experienced transitory diarrhea, and seven patients experienced brief apneic episodes. These events were all generally less severe than those typically associated with intravenous PGE. seen with IV PGE1.

Conclusion: When IV PGE1 is not available, oral PGE2 is a feasible and efficient substitute for preserving ductal patency in newborns with ductus-dependent congestive heart failure. The therapy was a useful choice in resource-constrained contexts since it provided for sustained ductal patency with controllable adverse effects.