ORIGINAL ARTICLE

Transporting newborn infants with suspected duct dependent congenital heart disease on low-dose prostaglandin E1 without routine mechanical ventilation

Kathryn A Browning Carmo¹, Peter Barr², Maureen West¹, Neil W Hopper¹, Jennifer P White¹ and Nadia Badawi²

¹ New South Wales newborn and paediatric Emergency Transport Service, Sydney, NSW, Australia
² The Children’s Hospital at Westmead, Sydney, NSW, Australia

Correspondence to:
Correspondence to:
Dr P Barr
Department of Neonatology, The Children’s Hospital at Westmead, Locked Bag 4001,Westmead, NSW, 2145, Australia; peter{at}chw.edu.au

Aim: 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 15 ng/kg/min of PGE1. Apnoea was more likely to occur in non-ventilated infants when the PGE1 infusion rate was 15 ng/kg/min compared with <15 ng/kg/min (14/33 vs 4/61, 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.

Abbreviations: CHD, congenital heart disease; PGE1, prostaglandin E1

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This article has been cited by other articles:

• Meckler, G. D., Lowe, C. (2009). To Intubate or Not to Intubate? Transporting Infants on Prostaglandin E1. Pediatrics 123: e25-e30 [Abstract] [Full Text]  
• Ferrarese, P., Marra, A., Doglioni, N., Zanardo, V., Trevisanuto, D. (2007). Routine mechanical ventilation for transferred neonates with duct-dependent congenital heart disease. Arch. Dis. Child. Fetal Neonatal Ed. 92: F422-F422 [Full Text]