104 - Clinical and echocardiographic response to prostaglandin E1 (PGE) infusion for persistent pulmonary hypertension of the newborn (PPHN)

Poster Number: 104
Publication Number: 104.426

Stephanie M. Tsoi, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Hassan Almeneisi, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Hythem Nawaytou, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Martina Steurer, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Jeffrey Fineman, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States; Roberta Keller, UCSF Benioff Children's Hospital San Francisco, San Francisco, CA, United States

Background: PPHN is the failure to undergo the normal fetal to postnatal transition. Elevated pulmonary vascular resistance, hypoxia, and right ventricular (RV) dysfunction result, which may cause low cardiac output and end-organ damage. Treatments targeting RV dysfunction, and subsequently cardiac output, include inotropic infusions and extracorporeal life support (ECLS). PGE infusion, used to maintain ductal patency in order to decompress and improve RV function, may result in preserved cardiac output at the expense of lower post-ductal oxygen saturations.

Objective: To describe the effect of PGE on RV function and cardiac output in neonates with PPHN.

Design/Methods: Single-center retrospective cohort study including newborns born 2015–20 with gestational age ≥ 35 weeks. Additional inclusion criteria were initiation of inhaled nitric oxide (iNO) by 7d of age or PPHN diagnosis. Newborns were excluded if they had complex congenital heart disease or diaphragmatic hernia. Clinical parameters and echocardiograms (echos) were overread by investigators to assess systolic function (fractional area change, FAC) and RV afterload (pulmonary arterial acceleration time/RV ejection time, PAAT/RVET); echos on ECLS were excluded. Paired t test was used to compare echo indices after initiation (On) and discontinuation (Post) of PGE to those prior to PGE initiation (Pre), and hemodynamic indices before and 24h after PGE initiation.

Results: 48 neonates received PGE for management of PPHN (Table 1); RV pressure was estimated at systemic-to-suprasystemic in 30/32 patients with pre-PGE initiation echo. PGE1 was initiated at mean 2.1±1.9d of age, continued for mean 6.2±3.8d (range 1-21d), and discontinued at mean 7.4±4.0d of age. Serial echos suggested improved systolic function (increased FAC) and decreased afterload (increased PAAT/RVET) over the 3 time points (Figure). Paired analyses showed no change in FAC and non-significant improvement in PAAT/RVET while on PGE, but measurable improvement in both indices post-PGE (Table 1).  Hemodynamic indices (excluding those on ECLS) improved with PGE initiation; lactate level, heart rate and pre-ductal oxygen saturation index decreased, and vasoactive-inotropic score modestly increased (Table 2).

Conclusion(s): The use of PGE for ductal patency in PPHN is associated with early improvement in hemodynamic indices and maintenance of RV systolic function, with later improvements in RV function and afterload. PGE may be a useful adjunctive therapy in severe PPHN.