From the Guidelines
Apnea is a known adverse reaction of prostaglandin E1 (PGE1) infusion, and healthcare providers should be prepared to provide respiratory support if needed. PGE1, also known by the generic name alprostadil, can cause respiratory depression and apnea, particularly when administered to neonates with congenital heart defects, as noted in a study published in Pediatrics in 2008 1. This side effect typically occurs within the first hour of initiating therapy or after increasing the dose. The risk of apnea is dose-dependent and more common at higher doses. For this reason, respiratory monitoring is essential during PGE1 administration, especially during initiation and dose adjustments. Some key points to consider when administering PGE1 infusion include:
- Being prepared to provide respiratory support if needed, as apnea may occur 1
- Monitoring for other potential adverse effects, such as hyperthermia and seizures, as noted in the same study 1
- Understanding the mechanism behind PGE1-induced apnea, which involves its effect on the central nervous system, where it can depress the respiratory center. Other options, such as hypertension, hypothermia, and thrombocytosis, are not commonly associated with PGE1 infusion as adverse reactions, and the focus should remain on monitoring and managing apnea and other known adverse effects, such as fever, flushing, hypotension, and seizures.
From the Research
Known Adverse Reactions of Prostaglandin E1 Infusion
- Apnea is a known adverse reaction of prostaglandin E1 (PGE1) infusion, as reported in several studies 2, 3, 4, 5, 6
- The occurrence of apnea is often dose-dependent and can occur within 48 hours after initiation of PGE1 therapy 2
- Other common side effects of PGE1 infusion include cutaneous vasodilation, bradycardia, tachycardia, hypotension, seizure-like activity, hyperthermia, and fever 3
Comparison of Options
- Apnea is a recognized adverse reaction of PGE1 infusion, whereas hypertension and thrombocytosis are not commonly reported side effects 2, 3, 4, 5, 6
- Hypothermia is not typically associated with PGE1 infusion, and hyperthermia is more commonly reported 3, 4
Studies on PGE1 Infusion
- A study published in 2023 found that standardizing a protocol for initiating PGE1 in prenatally diagnosed ductal-dependent CHD was successful and reduced the incidence of apnea, fever, and sepsis evaluations 2
- Another study published in 1993 noted that nurses caring for neonates receiving PGE1 therapy must have knowledge of all its potential side effects, including apnea 3
- A 2013 study recommended treating early newborns with CHD and PDA-dependent pulmonary circulation with a lower initial dose of PGE1 to minimize complications such as apnea 4
- A randomized clinical trial published in 2025 investigated the effects of caffeine therapy on the occurrence of apnea in neonates with CHD receiving PGE1, but found no statistically significant difference between the caffeine and control groups 5
- A 2009 study described the pretransport and transport management of infants receiving PGE1 infusion for congenital heart disease and found that likely PGE1 adverse effects included apnea in 18% of infants 6