title: Coumarin embryopathy in an extremely low birth weight infant associated with neonatal hepatitis and ocular malformations.
abstract: Coumarin embryopathy (CE) is a well-documented sequelae of prenatal exposure to vitamin K antagonists. We report on a female premature infant (25 weeks' gestation) born to a mother who had received phenprocoumon during pregnancy following mechanical heart valve replacement. The infant presented with impaired coagulation, intraventricular and minor parenchymal cerebral haemorrhages and midface hypoplasia typical of CE. In addition, there was hepatopathy with conjugated hyperbilirubinemia, elevated liver enzymes and repeated episodes of hypoglycemia upon attempts to discontinue glucose supplementation, all lasting for 4 months. There was corneal opacity with anterior segment dygenesis in the left eye, and persistent pupillary membrane, cataract and persistent hyperplastic primary vitreous in the right eye. While liver disease is an uncommon but serious side effect of vitamin K antagonists, this is the first report describing neonatal hepatopathy as part of CE. In anticoagulation of pregnant women with mechanical heart valves, vitamin K antagonists should be used with utmost restraint.
authors.affiliation: Department of Neonatology, University Children's Hospital, Basel, Switzerland. patrick.hetzel@ukbb.ch
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Hetzel
authors.forename: René
authors.initials: R
authors.lastname: Glanzmann
authors.forename: Pascal W
authors.initials: PW
authors.lastname: Hasler
authors.forename: Ariane
authors.initials: A
authors.lastname: Ladewick
authors.forename: Christoph
authors.initials: C
authors.lastname: Bührer
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000209:etiology*; D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D003318:Corneal Opacity / Q000139:chemically induced; D004697:Endocarditis, Bacterial / Q000601:surgery*; D005124:Eye Abnormalities / Q000209:etiology*; D005145:Face / Q000002:abnormalities; D005260:Female; D005333:Fetus / Q000187:drug effects*; D006350:Heart Valve Prosthesis; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D010644:Phenprocoumon / Q000009:adverse effects*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000601:surgery*; D013923:Thromboembolism / Q000517:prevention & control
chemical_list: D000925:Anticoagulants; D010644:Phenprocoumon