BONE AND TISSUE CHANGES FOLLOWING PROSTAGLANDIN THERAPY IN NEONATES

OBJECTIVE: TO review case reports describing prostaglandin-induced bon e changes and tissue swelling in neonates. DATA SOURCES: An Index Medi cus and bibliographic search of the English-language literature pertai ning to prostaglandin-induced bone changes and tissue swelling in neon ates. DATA SYNTHESIS: Short- and long-term prostaglandin infusion in n eonates is associated with cortical proliferation throughout the skele tal system. Total resolution of these changes has occurred in seven pa tients described to date; other reports did not note either the time o r the regression of these changes. Skeletal changes may occur within 9 days of initiation of prostaglandin therapy and include widened fonta nelles, pretibial and soft-tissue swelling, and swelling of the upper and lower extremities. These reactions may last up to 38 weeks followi ng discontinuation of therapy. Alkaline phosphatase (AP) concentration s have been shown to be increased in four cases, as well as in one ret rospective analysis. Although these were not prospective studies, eval uation of AP may provide a means to monitor neonates receiving prostag landin therapy. CONCLUSIONS: Pharmacists need to be aware of the poten tially serious skeletal changes, encourage dosage titration as soon as possible, and limit the duration of time neonates are exposed to pros taglandin therapy. Monitoring of AP concentrations during therapy with prostaglandins may be beneficial in predicting or preventing further complications.