Premature closure of ductus arteriosus after a single dose of diclofenac during pregnancy. Issue 6 (24th June 2021)

• Record Type: Journal Article
• Authors: dos Santos, Constança Soares; Silva, Patricia Vaz; Castelo, Rui; Tiago, Joaquim
• Is Part Of: BMJ case reports. Volume 14:Issue 6(2021)
• Publication Date: 2021-06-24
• Subjects: paediatrics -- congenital disorders -- materno-fetal medicine -- neonatal and paediatric intensive care -- cardiovascular medicine; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2021-243485
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : 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.