Standardizing Prostaglandin Initiation in Prenatally Diagnosed Ductal-Dependent Neonates; A Quality Initiative

Pediatr Cardiol. 2023 Aug;44(6):1327-1332. doi: 10.1007/s00246-022-03075-9. Epub 2022 Dec 20.


Prostaglandin E1 (PGE) is used in patients with ductal-dependent congenital heart disease (CHD). Side effects of apnea and fever are often dose dependent and occur within 48 h after initiation. We initiated a standardized approach to PGE initiation after our institution recognized a high incidence of side effects and a wide variety of starting doses of PGE. Neonates with prenatally diagnosed ductal-dependent CHD were identified, started on a standardized protocol that started PGE at 0.01 mcg/kg/min, and evaluated for PGE related side effects. Compliance, outcomes and dose adjustments during the first 48 h post-PGE initiation were evaluated. Fifty patients were identified (25 pre-intervention; 25 post-intervention). After intervention, compliance with the protocol was 96%, and apnea or fever occurred in 28% (compared to 63% pre-intervention, p = 0.015). Dose adjustments (either increase or decrease) prior to cardiac surgery were similar in both cohorts (60%, 52%, p = 0.569). There were no mortalities or emergent procedures performed due to ductus arteriosus closure. Standardizing a protocol for initiating PGE in prenatally diagnosed ductal-dependent CHD was successful and reduced the incidence of apnea, fever, and sepsis evaluations. A starting dose of 0.01 mcg/kg/min did not cause increased adverse effects.

Keywords: Intervention; Neonates; Outcomes; Quality improvement.

MeSH terms

  • Alprostadil / therapeutic use
  • Apnea / chemically induced
  • Apnea / drug therapy
  • Cardiac Surgical Procedures*
  • Ductus Arteriosus, Patent* / diagnostic imaging
  • Ductus Arteriosus, Patent* / drug therapy
  • Heart Defects, Congenital* / surgery
  • Humans
  • Infant, Newborn
  • Prostaglandins


  • Alprostadil
  • Prostaglandins