In the neonate with a congenital heart defect, prostaglandin E₁ (PGE₁) can be life saving. PGE₁ dilates the ductus arteriosus, providing pulmonary or systemic blood flow in infants with ductal-dependent lesions. PGE₁ is often started as soon as the cardiac defect is recognized and continued until the infant has reached the center where definitive treatment can be performed.

There has been concern, however, that because one side effect of PGE₁ is apnea, neonates transported while receiving the drug should be electively intubated prior to transport. Intubating the infant obviates the need to secure an airway in case of an emergency during transport, should apnea occur. Because endotracheal intubation and transporting the neonate on mechanical ventilation are associated with their own risks, a study was conducted to compare complications that occur during transport of intubated and unintubated neonates on PGE₁.

A retrospective review of infants with a diagnosis of congenital heart defect who were transported during a 5-year period showed that the most common cardiac defect was hypoplastic left heart syndrome (25%), followed by transposition of the great arteries (19%) and coarctation of the aorta (15%). Apnea occurred in 18% of the infants. Major complications occurred during 42% of all transports, including 7 of the unintubated infants and 14 of the prophylactally intubated infants. Elective intubation was the strongest independent predictor of transport complications such as cardiac arrhythmia, hypotension, apnea, hypoventilation, desaturation requiring intervention, and displaced endotracheal tube. The risks of elective pretransport intubation must be therefore weighed carefully against possible benefits of this procedure in neonates on PGE₁.

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