Nursing care of the neonate receiving prostaglandin E1 therapy.

In 1981, the Food and Drug Administration approved prostaglandin E1 (PGE1) for use in the treatment of neonates with congenital heart disease. PGE1 is commonly used in neonatal and pediatric intensive care units to maintain patency of the ductus arteriosus in those cardiac lesions that depend on the ductus for either systemic or pulmonary blood flow. Early recognition of hemodynamic instability and prompt initiation of PGE1 therapy is vital to survival in neonates with ductal-dependent cardiac lesions. Administration of PGE1 allows delay of palliative or corrective surgery until stabilization or transfer of the neonate to a tertiary care facility is achieved. It is also used as a bridge to heart transplantation in neonates in whom this treatment is an option. Congenital anomalies requiring treatment with PGE1 are those that restrict pulmonary blood flow (cyanotic or right-sided outflow tract obstructions) and systemic blood flow (acyanotic or left-sided outflow tract obstructions). Prostaglandin E1 is excreted by the kidneys, and elimination is almost complete within 24 hours after administration; 80 percent of it is rapidly metabolized after one pass through the pulmonary bed. Therefore, a continuous infusion and adequate intravenous access are necessary. Nurses caring for these neonates must have knowledge of all its potential side effects. Some of the most common side effects include cutaneous vasodilation, bradycardia, tachycardia, hypotension, seizure-like activity, hyperthermia, and apnea.