180 - Low-Dose Vs. High-Dose Prostaglandin E1 for Ductal-Dependent Congenital Heart Disease - A Systematic Review and Meta-Analysis.

Poster Number: 180
Publication Number: 180.2821

Background: Prostaglandin E1 is a medication used to keep the ductus arteriosus open in infants with critical congenital heart disease (CHD). The standard starting dose is 0.05 μg/kg/minute, but sometimes lower doses are given. However, it is not clear whether a low-dose regimen of prostaglandin E1 is as effective and safe as the standard dose.

Objective: Compare treatment outcomes in infants (≥30 weeks gestation) with ductal-dependent cardiac lesions treated with low-dose prostaglandin E1 (≤0.01 mcg/kg/min) versus any other dose.

Design/Methods: We systematically searched Pubmed, EMBASE, and Cochrane databases for randomized controlled trials (RCTs) and observational studies to assess outcomes of low-dose prostaglandin E1 (≤ 0,01 mcg/kg/min) with any other dose regimen in term and preterm infants (≥30 weeks gestation) with ductal-dependent cardiac lesions. Statistical analysis was conducted using Review Manager version 5.4, and heterogeneity was assessed through Cochrane's Q test and I2 statistics.

Results: We analyzed 290 neonates from 5 observational studies. No RCT was published. Neonates treated with a low-dose prostaglandin E1 regimen had a significantly lower incidence of fever (RR 0.40; 95% CI 0.17-0.97; p=0.04; I2=0%) (Figure 1). There was no significant difference between low-dose and standard-dose PGE1 regimens with regards to apnea (26.9% vs. 33.3%, respectively; RR 0.83; 95% CI 0.39-1.77; p=0.63; I2=31%); need for intubation (8.9% vs. 5.3%, respectively; RR 1.08; 95% CI 0.16-7.40; p=0.94; I2=46%) (Figure 2); need for dose adjustment - increase low-dose regimen or decrease higher doses (15.3% vs. 40.2%, respectively; RR 0.32; 95% CI 0.09-1.12; p=0.07; I2=69%) (Figure 3).

Conclusion(s): Compared to the standard initial dose, a low-dose prostaglandin E1 treatment has been found to reduce the incidence of fever significantly. The study found no significant differences in the occurrence of apnea, need for intubation, or necessary dose adjustments. These results suggest that it may be required to re-evaluate current guidelines for standard dosing.