Prostaglandin induced cortical hyperostosis in neonates with cyanotic heart disease.
OBJECTIVE
To study the side effects of prolonged prostaglandin therapy especially hyperostosis and other musculoskeletal changes.


METHODS
Case files of the neonates, with cyanotic heart disease, who had received prostaglandin infusion from early days of life, were reviewed. Patients with periosteal changes were identified. Their radiographs, serum alkaline phosphatase activity, duration and dose of prostaglandin and other side effects related to the prostaglandin were studied.


RESULTS
Ten patients developed hyperostosis, who had received PGE1 infusion for a period of 9 to 195 days. Two babies developed coarse facial features, hypertrichosis, and edema of extremities and digital swelling. Serum alkaline phosphatase activity was significantly raised in the patients, with hyperostosis. Besides long bones, ribs and scapulae, the clavicles were also involved. The involvement of clavicles has not been previously reported.


CONCLUSIONS
Hyperostosis is a common side effect of prolonged prostaglandin therapy. Abnormal facial features, hypertrichosis and coarse skin are additional adverse effects of long term therapy. Serum alkaline phosphatase activity can be used as a marker of the hyperostosis. In addition to other bones clavicles can also be involved. The above effects seem to be both dose and duration dependent.
Nadroo
A M
AM
Department of Pediatrics, Maternity and Children Hospital, Riyadh Medical Complex, Riyadh, Kingdom of Saudi Arabia. Anadroo@yahoo.com
Shringari
S
S
Garg
M
M
al-Sowailem
A M
AM
D000469:Alkaline Phosphatase / Q000097:blood; D000527:Alprostadil / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D003490:Cyanosis; D004487:Edema / Q000139:chemically induced; D005260:Female; D006330:Heart Defects, Congenital / Q000188:drug therapy*; D006801:Humans; D015576:Hyperostosis / Q000139:chemically induced* / Q000000981:diagnostic imaging; D006983:Hypertrichosis / Q000139:chemically induced; D007231:Infant, Newborn; D008297:Male; D011859:Radiography
D000469:Alkaline Phosphatase; D000527:Alprostadil