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

Kathryn Browning Carmo ¹, Peter Barr ^2*, Maureen West ¹, Neil Hopper ¹, Jennifer White ¹ and Nadia Badawi ³

¹ New South Wales newborn and paediatric Emergency Transport Service, Australia
² Children's Hospital at Westmead, Australia
³ The Children's Hospital at Westmead, and the University of Sydney, Australia

^* To whom correspondence should be addressed. E-mail: peter{at}chw.edu.au.

Accepted 1 August 2006

Abstract

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 (MV).

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: MV was not used prior to treatment with PGE1 in 94 (31%) of the 300 infants. The indications for MV in the remaining 206 infants (69%) included elective MV because of the intention to use PGE1 (N = 125) and severe hypoxaemia, acidosis or cardiorespiratory failure prior to commencing PGE1 (N = 81). Sixteen (17%) of the 94 infants who were not ventilated initially required MV before transport because of apnoea, which developed within one hour of commencing PGE1. Two (2.6%) of the 78 infants transported without MV 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 versus 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 MV for safe transport.

Keywords: infant, newborn, prostaglandin E1, respiration, artificial

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