PROSTAGLANDIN-INDUCED NEONATAL PERIOSTITIS

Prostaglandins are being commonly used to maintain the patency of the ductus arteriosus in infants with congenital ductal-dependent heart di sease. A significant and unusual side effect of this drug treatment is the symmetrical development of periostitis of the long bones. A revie w of neonates with congenital heart disease requiring prostaglandin tr eatment at the Children's Hospital of Eastern Ontario revealed five in fants who developed periostitis, the earliest onset being after 14 day s of prostaglandin infusion. The drug dosage varied in these infants f rom 0.02 to 0.10 mu g/kg/min, The periostitis was associated with limb pain and considerable swelling of the extremities in ail children. Th e periostitis improved on cessation of the prostaglandin infusion, and by 6 weeks after the cessation of the drug, the periostitis had decre ased significantly. Periostitis seemed more dependent on the duration of administration of the prostaglandin than on the dosage of prostagla ndin administered. Awareness of this entity is essential not only for the treatment team caring for these infants but also for consultant pe diatric orthopaedists to avoid excessive investigation for infection, metabolic disease, or vitamin deficiencies that resemble prostaglandin -induced periostitis.