see [[Congenital heart disease]] [RCH PGE-1](https://www.rch.org.au/piper/neonatal_medication_guidelines/Alprostadil_(Prostin_VR)_%E2%80%93_(Prostaglandin_E1)/) #congenital-heart Prostaglandin E1 (PGE1), *alprostadil* 0.05-1 μg/kg/min (50-100 nanograms/kg/min) > [!key points] note on dose > RCH guideline notes: > - **0.1 micrograms/kg/minute** (100 nanograms/kg/min) to *open* a closed ductus. An *effect is usually seen within 30-60 minutes*. Reduce the dose once an effect is seen or as directed by a Consultant. Doses > 0.1 micrograms/kg/minute are rarely more effective and may cause serious adverse effects > - 0.01 to 0.02 micrograms/kg/minute (10-20 nanograms/kg/min) to maintain patency **Indications** 1. hypoxic cyanotic baby not very responsive to oxygen 2. shock acidotic baby not responsive to fluids/gets worse with IVF > often running blind, but suspect baby has a duct-dependent lesion > therefore, start PGE1, monitor for side effects, and consider/treat differential diagnoses concurrently: > - IVF > - abx > - glucose > - supportive care > > *consider intubation* for transport given aponea risks if getting PGE1 **side effects** - aponea (most common; ~30%) - usually occurs in neonates under 2 kg within the first hour of administration. - fever - seizures - bradycardia - hypotension - flushing **contraindications** On balance ==it is appropriate to use in sick patients with suspected but undiagnosed congenital heart disease== *even if* total anomalous pulmonary venous return with obstruction has not been ruled out.