Do Predictors Exist for a Successful Withdrawal of Preoperative Prostaglandin E₁ from Neonates with d-Transposition of the Great Arteries and Intact Ventricular Septum?

Prostaglandin E₁ (PGE₁) is given to neonates with d-transposition of the great arteries (d-TGA) to reduce cyanosis by reopening and maintaining the patency of the ductus arteriosus. To avoid side effects, this medication can be stopped for hemodynamically stable patients after balloon atrial septostomy (BAS). A consecutive series of neonates with d-TGA and an intact ventricular septum (IVS) presenting from 2000 through 2005 was analyzed retrospectively to search for side effects of PGE₁ and to identify predictors for a safe preoperative withdrawal. The medication was stopped for hemodynamically stable patients with transcutaneous oxygen saturations higher than 80% after BAS and reinitiated for patients with an oxygen saturation lower than 65%. Patients successfully weaned were compared with those who had failed weaning in terms of atrial septal defect (ASD) size, ductus arteriosus size, and the transcutaneous oxygen saturation. Prostaglandin E₁ was initiated for all 43 neonates with d-TGA. The median maintenance dose of PGE₁ was 0.00625 μg/kg/min (range, 0.00313–0.050 μg/kg/min) for a median duration of 6 days (range, 1–12 days). For 16 patients, PGE₁ was preoperatively withdrawn but then had to be reinitiated for 7 of the 16 patients. No predictors for a successful weaning of PGE₁ were found based on ASD size, ductus arteriosus size, or oxygen saturation. The adverse effects of PGE₁ were apnea in 10 patients and fever in 19 patients. Neither seizures nor necrotizing enterocolitis was documented. Prostaglandin E₁ was successfully withdrawn for a minority of hemodynamically stable patients with d-TGA. No predictors for a successful weaning could be identified. Because apnea and fever are common side effects, withdrawal of PGE₁ after BAS may improve patient safety and comfort. In this patient group, if PGE₁ withdrawal was not well tolerated, it could be safely reinitiated. There were no serious side effects of PGE_1.