Transporting newborn infants with suspected duct dependent congenital heart disease on low-dose prostaglandin E1 without routine mechanical ventilation.
OBJECTIVE
To evaluate the safety of transporting newborn infants with suspected duct dependent congenital heart disease (CHD) treated with prostaglandin E1 (PGE1) without routine mechanical ventilation.


METHODS
A retrospective population-based audit of newborn infants with suspected CHD transported on PGE1 by the New South Wales newborn and paediatric Transport Service from 1995 through 2005.


RESULTS
Mechanical ventilation was not used prior to treatment with PGE1 in 94 (31%) of the 300 infants. The indications for mechanical ventilation in the remaining 206 infants (69%) included elective mechanical ventilation because of the intention to use PGE1 (n = 125) and severe hypoxaemia, acidosis or cardiorespiratory failure prior to commencing PGE1 (n = 81). 16 (17%) of the 94 infants who were not ventilated initially required mechanical ventilation before transport because of apnoea, which developed within one hour of commencing PGE1. 2 (2.6%) of the 78 infants transported without mechanical ventilation developed apnoea in transit and both were receiving >or=15 ng/kg/min of PGE1. Apnoea was more likely to occur in non-ventilated infants when the PGE1 infusion rate was >or=15 ng/kg/min compared with <15 ng/kg/min (14/33 vs 4/61, chi(2) = 15.55, p<.001).


CONCLUSIONS
Newborn infants with suspected duct dependent CHD treated with low dose PGE1 (<15 ng/kg/min) may not require mechanical ventilation for safe transport.
Browning Carmo
Kathryn A
KA
New South Wales newborn and paediatric Emergency Transport Service, Sydney, NSW, Australia.
Barr
Peter
P
West
Maureen
M
Hopper
Neil W
NW
White
Jennifer P
JP
Badawi
Nadia
N
D000527:Alprostadil / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D006330:Heart Defects, Congenital / Q000188:drug therapy*; D006801:Humans; D007231:Infant, Newborn; D009517:New South Wales; D018743:Perinatal Care / Q000379:methods*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014187:Transportation of Patients / Q000379:methods*
D000527:Alprostadil