title: Severe pulmonary hypertension with therapeutic L-lysine ibuprofen in 2 preterm neonates.
abstract: Persistently patent ductus arteriosus (PDA), affecting approximately one-third of all very low birth weight infants, can lead to significant morbidity and mortality. Recently, ibuprofen has been recommended over indomethacin to close PDAs because of a reduction in risk of necrotizing enterocolitis. Pulmonary hypertension is a rare but potentially fatal complication of ibuprofen administration in preterm infants. We report 2 infants who developed this complication after receiving therapeutic L-lysine ibuprofen preparation for the PDA closure. The first infant, 1 of twins weighing 640 g, was born at 24 weeks' gestation. The second infant, born at 26 weeks' gestation, was small for gestational age, weighing 439 g. In both cases, ibuprofen was initiated after echocardiographic confirmation of a moderate-sized to large PDA and an otherwise normal intracardiac anatomy. Both infants had echocardiographic evidence of increased pulmonary vascular resistance but shunting across the PDA was left to right. The infants deteriorated within 48 to 72 hours, and repeat echocardiograms revealed evidence of severe pulmonary hypertension. Both infants died of refractory hypotension and hypoxemia. When considering the use of ibuprofen therapy for PDA closure, clinicians should keep in mind the potential serious complication of pulmonary hypertension, even if a shunt across the PDA is left to right.
authors.affiliation: Department of Pediatrics, Cooper University Hospital, Camden, New Jersey 08103, USA. amendolia-barbara@cooperhealth.edu
authors.forename: Barbara
authors.initials: B
authors.lastname: Amendolia
authors.forename: Madeline
authors.initials: M
authors.lastname: Lynn
authors.forename: Vishwanath
authors.initials: V
authors.lastname: Bhat
authors.forename: Steven B
authors.initials: SB
authors.lastname: Ritz
authors.forename: Zubair H
authors.initials: ZH
authors.lastname: Aghai
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D004200:Diseases in Twins / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004374:Ductus Arteriosus, Patent / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004452:Echocardiography; D017809:Fatal Outcome; D006801:Humans; D006976:Hypertension, Pulmonary / Q000139:chemically induced* / Q000000981:diagnostic imaging; D007052:Ibuprofen / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000139:chemically induced* / Q000000981:diagnostic imaging; D007236:Infant, Small for Gestational Age; D008239:Lysine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D008297:Male
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D008239:Lysine; C016106:solufenum; D007052:Ibuprofen