Prostaglandin Availability and Association with Outcomes for Infants with Congenital Heart Disease.
Data regarding availability of prostaglandin E1 (PGE) and its impact on the stabilization, transport, critical care course, and surgical outcome of infants with ductal-dependent congenital heart disease in the current pediatric healthcare environment are unknown. We sought to determine the proportion of hospitals in Texas that stock PGE and to investigate associations between PGE availability and clinical outcomes. All birth institutions listed with the Texas Department of Health and Human Services were contacted to determine PGE availability as of 2011. Outcomes of all infants admitted to our institution from 2007 to 2012 who received PGE for ductal-dependent lesions were evaluated. PGE was stocked in 50 % (n = 139) of hospitals that performed deliveries in Texas in 2011 representing 79.1 % (303, 481) of births. Hospitals that did not stock PGE had less annual births and were located a further distance from a center that provided pediatric cardiac surgical services. Patients born at a hospital that did not stock PGE had significantly greater serum lactate and creatinine (p = 0.002) and serum lactate on admission (p < 0.001). The PGE availability was not associated with hospital length of stay, postoperative length of stay, or mortality. When stratifying in TGA and HLHS subgroups, lack of PGE availability remained associated with higher creatinine, higher lactate, lower glucose, and lower pH. PGE is not universally available in all healthcare institutions providing obstetrical services. Lack of availability of PGE at an outlying hospital was associated with increased morbidity, but was not associated with mortality or length of stay.
Department of Pharmacy, Texas Children's Hospital, Houston, TX, USA.
Brady S
BS
Moffett
Department of Pharmacy, Texas Children's Hospital, Houston, TX, USA.|College of Pharmacy, University of Houston, Houston, TX, USA.
Joshua M
JM
Garrison
Department of Pharmacy, Texas Children's Hospital, Houston, TX, USA.|College of Pharmacy, University of Houston, Houston, TX, USA.
Aimee
A
Hang
The Section of Cardiology, Department of Pediatrics, Texas Children's Hospital and the Baylor College of Medicine, Houston, TX, USA.
Shaine A
SA
Morris
The Sections of Critical Care Medicine and Cardiology, Department of Pediatrics, Texas Children's Hospital and the Baylor College of Medicine, Houston, TX, USA.
Rocky
R
Tsang
Department of Pharmacy, Texas Children's Hospital, Houston, TX, USA.
Kimberly
K
Dinh
The Section of Newborn Medicine, Department of Pediatrics, Texas Children's Hospital and the Baylor College of Medicine, Houston, TX, USA.
Pamela
P
Griffiths
The Sections of Critical Care Medicine and Cardiology, Department of Pediatrics, Texas Children's Hospital and the Baylor College of Medicine, Houston, TX, USA.
Ronald
R
Bronicki
The Sections of Critical Care Medicine and Cardiology, Department of Pediatrics, Texas Children's Hospital and the Baylor College of Medicine, Houston, TX, USA. checchia@bcm.edu.
Paul A
PA
Checchia
D000527:Alprostadil / Q000600:supply & distribution*; D016550:Birthing Centers / Q000706:statistics & numerical data; D003422:Critical Care; D004865:Equipment and Supplies, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006330:Heart Defects, Congenital / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D009017:Morbidity; D015999:Multivariate Analysis; D013781:Texas; D014665:Vasodilator Agents / Q000600:supply & distribution*
D014665:Vasodilator Agents; D000527:Alprostadil
Cardiac surgery; Patent ductus arteriosus; Pediatric; Prostaglandin