Prostaglandins: Preventing the Cardiac Clamp Down

The treatment required for infants who are born with congenital heart disease varies greatly depending on the type of heart condition that they have. For some infants, no medical intervention is required just observation of physical signs and symptoms. Even for those infants who do require medical intervention there is a significant variation, some only require pharmaceutical intervention while others require more intensive surgical intervention. The timing of medical intervention also varies quite a bit. For some congenital cardiac conditions, immediate medical intervention is required yet for others, surgical intervention is optimal once the infant has grown and gained a bit of weight.

When a fetus is the womb, it doesn’t require blood to circulate through their lungs. So the blood is diverted away from the lungs by an artery called ductus arteriosus. At the time of delivery when the umbilical cord is clamped, the circulation pattern for the newborn changes. However, with some cardiac conditions, it is beneficial for the circulation to remain as it was in the womb. In these situations, prostaglandin treatment will be ordered. The administration of prostaglandin promotes dilatation of ductus arteriosus so that the ductal shunting can continue in order for the newborn to get better oxygenation and perfusion.

Prostaglandins are given to the baby via intravenous line. Those infants who receive prostaglandins must be monitored closely due to significant side effects. Some of those side effects include periodic interruptions in breathing (or apnea), obstruction of the gastric outlet, abnormal bone growth, and high fever. Possible safety areas of concern regarding prostaglandin are incorrect administration of the medication, and the inability to assess side effects that would necessitate medical intervention.

Sometimes prostaglandins are used in an emergency condition to prevent the duct from clamping down too quickly. One example of this is with the medical treatment of Patent Ductus Arterious. As discussed earlier, after delivery a newborn’s blood circulation alters so that the lungs will now have blood flow through them in order for the newborn to breathe on their own. As a part of this process, the Patent Ductus Arterious closes. For some infants this does not happen on its own. Sometimes, the open PDA is just monitored but other times it needs to be closed by medication or surgery. The medication used to close the PDA is Indocin. It is given over a few days and under a very specific regimen. However, a serious side effect of Indocin is that it can cause the closure to happen too quickly and thus the infant’s condition can quickly deteriorate. When this happens prostaglandins are administered to help reverse the effects of the clamp down.

For more information on prostaglandins and cardiac conditions please contact our office to schedule a conference.

Reference:

McNamara, P. (2006) Drug Treatment of Congenital Heart Defects. Retrieved August 2007 from http://www.aboutkidshealth.ca/PrematureBabies/Drug-Treatment-Congenital-Heart-Defects.com

Young, T.E. & Mangum, B. (2003) Prostaglandin E. Neofax Sixteenth Ed. Pp. 124-125.