Intravenous prostaglandin therapy is well established for maintaining or re-opening the arterial duct in newborns with duct dependent congenital heart disease. An important side effect of prostaglandin therapy is its tendency to cause apnoea. Hence elective intubation and ventilation is usually considered for infants who are transferred between hospitals soon after starting such an infusion.¹ The article from Dr Browning Carmo et al²(see page xxx) provides an excellent justification for transporting such infants on intravenous prostaglandin without routine mechanical ventilation. However, although the authors do comment that this may also be suitable for infants with known duct dependent heart disease (ie diagnosed antenatally), they have not highlighted how many, if any, of their own study group fall within this category.

These patients are a challenging group and represent the worst end of the spectrum of congenital heart disease.^3,4 Complex single ventricle lesions and severely obstructed systemic or pulmonary circulations are overrepresented compared to the spectrum of postnatally diagnosed problems. Despite this, their parents have usually already committed to active …