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- congenital disorders
- materno-fetal medicine
- neonatal and paediatric intensive care
- cardiovascular medicine
In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years.
A male term neonate was admitted to the neonatal intensive care unit in the first hours of life with central cyanosis. Echocardiogram showed severe biventricular hypertrophy, markedly right-sided, tricuspid regurgitation, a patent foramen ovale and a closed ductus arteriosus (CDA). The mother recalled being treated with a single dose of intravenous diclofenac for low back pain 2 weeks earlier. The newborn was started on propranolol with symptomatic improvement and was discharged on day 10. At 1-month follow-up, he showed complete resolution of ventricular hypertrophy and suspended propranolol. In the literature, of the 22 cases of CDA after intrauterine exposure to diclofenac, 11 resolved in utero, 3 required ventilatory and inotropic support and 1 evolved to persistent pulmonary hypertension. In this case, a thorough anamnesis was key to identify the probable cause of an otherwise unexplained transient ventricular hypertrophy. This case also alerts to the fetal risks of non-steroidal anti-inflammatory drugs during the third trimester, requiring close monitoring.
During pregnancy, the ductus arteriosus (DA) is critical for normal fetal circulation. It communicates the pulmonary artery to the aortic arch, allowing a right-to-left shunt, in which the oxygenated blood that reaches the right atrium from the placenta bypasses the highly resistant pulmonary circulation.1
The patency of the DA in utero is maintained by relative fetal hypoxia, by locally produced and circulating prostanoids (mainly Prostaglandin E1 (PGE1) and Prostaglandin E2 (PGE2), respectively) and by endothelial nitric oxide. As of the third trimester, DA becomes progressively more sensitive to …
Contributors CSS, PVS, RC and JT contributed to the planning, conception and design of the case report. Data acquisition, analysis and interpretation were performed by CSS. Image acquisition and interpretation were performed by CSS and PVS. CSS wrote the first draft of the manuscript and all authors commented on previous versions of the manuscript and revised it critically for important intellectual content. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.