CORTICAL HYPEROSTOSIS - A COMPLICATION OF PROLONGED PROSTAGLANDIN INFUSION IN INFANTS AWAITING CARDIAC TRANSPLANTATION

Background. Infants awaiting heart transplantation for congenital hear t disease frequently require prostaglandin E(1) (PGE(1)) infusion for prolonged periods. As a result, complications of prolonged PGE(1) infu sion, such as cortical hyperostosis, are being encountered more common ly. Objective. To determine the incidence and severity of cortical hyp erostosis in newborns requiring prolonged PGE(1) infusion. Methods. Ch est radiographs of 86 infants receiving PGE(1) infusion awaiting heart transplantation were reviewed. The chest radiographs were graded for the severity of cortical hyperostosis (no bony changes, minimal hypero stosis, or severe hyperostosis). Duration of PGE(1) infusion, total PG E(1) dose, and highest alkaline phosphatase were recorded for each pat ient. Infants were arbitrarily divided into three groups according to the duration of PGE(1) infusion (< 30 days, 30 to 60 days, > 60 days). Results. Fifty-three of the 86 infants (62%) had radiologic evidence of cortical hyperostosis. Forty-two of 80 infants (53%) had elevated a lkaline phosphatase. The percentage of infants with hyperostosis incre ased with increasing duration of PGE, infusion (42% at < 30 days; 87% at 30 to 60 days; 100% at > 60 days). The incidence and severity of co rtical hyperostosis were related (by Kruskal-Wallis) to the duration o f PGE(1) infusion (P < .0001) and the total dose of PGE(1) received (P < .0001). The highest alkaline phosphatase levels were observed in in fants with the most severe grades of hyperostosis (P < .0001). The per centage of infants with elevated alkaline phosphatase increased with g reater severity of hyperostosis (26% of infants with no bony changes, 59% with minimal changes, and 85% with severe changes). Two infants ha d symptomatic bone tenderness or swelling mimicking osteomyelitis. Con clusion. It is concluded that cortical hyperostosis is a frequent, oft en asymptomatic, side effect of prolonged PGE(1) infusion that should be evaluated in any infant on long-term PGE(1) therapy. When symptoms occur in infants awaiting transplantation, osteomyelitis must be exclu ded rapidly to avoid an unnecessary delay in transplantation.