Point-of-Care Ultrasound Optimizes the Preoperative Use of Prostaglandin E1 in Infants With Transposition of the Great Arteries.

BACKGROUND

This study aimed to determine the optimal dosages of prostaglandin E1 required to maintain a patent ductus arteriosus (PDA) in infants with transposition of the great arteries (TGA) based on point-of-care ultrasound (POCUS) findings.

METHODS

Infants with TGA were recruited from two groups (the historical control group and the POCUS group that received POCUS in combination with pulse oximetry saturation (SpO2) to titrate the dose of prostaglandin E1 (PGE1)).

RESULTS

A total of 150 patients were included in this study. The mean gestational ages were 38.6 weeks and 38.9 weeks, respectively, and the mean birth weights were 3.09 kg and 3.23 kg, respectively, in the control and POCUS groups. The rate of PGE1 prescriptions in the control group (93.3%) was higher than in the POCUS group (71.1%; p < 0.001). The time at which PGE1 was initiated (prenatally diagnosed) was earlier than in the control group (0.05 ± 0.01 vs. 1.66 ± 3.72 d; p < 0.001). The proportion of patients using a low dose (less than 5 ng/kg⋅min) of PGE1 was higher in the POCUS group (40.6% vs. 8.9%; p < 0.001). The multivariate logistic regression analysis indicated that implementing POCUS significantly reduces the dosage of PGE1.

CONCLUSION

POCUS can optimize the use of PGE1, reduce unnecessary usage, postpone the initiation of PGE1, minimize the maintenance dose, and reduce the impact dose. POCUS guidance enhances the safety and effectiveness of PGE1 in infants with TGA.