Specialty-Based Variation in Prostaglandin E1 Use for Neonates With dextro-Transposition of the Great Arteries: An International Cross-Sectional Survey of Neonatologists and Pediatric Cardiac Intensivists
Neonatal Medicine
Specialty-Based Variation in Prostaglandin E1 Use for Neonates With dextro-Transposition of the Great Arteries: An International Cross-Sectional Survey of Neonatologists and Pediatric Cardiac Intensivists
Neonatal Medicine

Specialty-Based Variation in Prostaglandin E1 Use for Neonates With dextro-Transposition of the Great Arteries: An International Cross-Sectional Survey of Neonatologists and Pediatric Cardiac Intensivists

World J Pediatr Congenit Heart Surg. 2026 Sep 8:21501351261472476. doi: 10.1177/21501351261472476. Online ahead of print.

ABSTRACT

OBJECTIVES: To assess international practice patterns for prostaglandin E1 (PGE1) initiation and dosing in neonates with dextro-transposition of the great arteries (d-TGA) and to evaluate whether these practices differ by clinical specialty.

METHODS: We conducted an international, cross-sectional, web-based survey of neonatologists and pediatric cardiac intensivists involved in stabilizing neonates with d-TGA. The survey assessed strategies for routine versus selective PGE1 initiation, oxygen saturation thresholds, starting dose, and maximum dose policies. The primary outcome was self-reported routine PGE1 initiation. Categorical variables were compared using χ2 tests, and multivariable logistic regression analysis identified independent predictors of routine initiation, adjusting for specialty, region, experience, cardiology availability, institutional protocols, and sex.

RESULTS: A total of 526 clinicians responded (282 neonatologists and 244 intensivists; 65.8% response rate). Neonatologists more frequently reported routine PGE1 initiation than cardiac intensivists (84.0% vs 58.6%, P < .001). Starting dose selection differed by specialty (P < .001), whereas oxygen saturation thresholds did not (P = .436). In adjusted analysis, cardiac intensivists were less likely than neonatologists to report routine initiation (adjusted OR 0.15, 95% CI 0.05-0.45).

CONCLUSIONS: Substantial specialty-based variation exists in PGE1 initiation and dosing for neonatal d-TGA stabilization. Because both routine and selective strategies have plausible physiologic rationale, this heterogeneity should be interpreted as hypothesis-generating, identifying the interspecialty divide as a priority target for prospective, outcome-linked comparative-effectiveness research that should precede any consensus recommendation. Limitations include the survey design, collinearity between specialty and care setting, and lack of patient-level outcome data.

PMID:42709749 | DOI:10.1177/21501351261472476