Prostaglandin induced cortical hyperostosis in neonates with cyanotic heart disease

Objective: To study the side effects of prolonged prostaglandin therapy esp ecially hyperostosis and other musculoskeletal changes. Methods: Case files of the neonates, with cyanotic heart disease, who had r eceived prostaglandin infusion from early days of life, were reviewed. Pati ents with periosteal changes were identified. Their radiographs, serum alka line phosphatase activity, duration and dose of prostaglandin and other sid e effects related to the prostaglandin were studied. Results: Ten patients developed hyperostosis, who had received PGE1 infusio n for a period of 9 to 195 days. Two babies developed coarse facial feature s, hypertrichosis, and edema of extremities and digital swelling. Serum alk aline phosphatase activity was significantly raised in the patients, with h yperostosis. Besides long bones, ribs and scapulae, the clavicles were also involved. The involvement of clavicles has not been previously reported. Conclusion: Hyperostosis is a common side effect of prolonged prostaglandin therapy. Abnormal facial features, hypertrichosis and coarse skin are addi tional adverse effects of long term therapy. Serum alkaline phosphatase act ivity can be used as a marker of the hyperostosis. In addition to other bon es clavicles can also be involved. The above effects seem to be both dose a nd duration dependent.