Prenatal exposure to methyldopa leading to hypertensive crisis and cardiac failure in a neonate.
A 2-week-old infant with normal intracardiac anatomy presented to the emergency department in a hypertensive crisis with acute cardiac failure. Despite extensive evaluation, no underlying disease was found. The patient's hypertension and cardiac dysfunction resolved after 1 week of supportive care in the PICU, and she was discharged within 2 weeks of presentation. The patient's history revealed transplacental exposure to the α-adrenergic agonist methyldopa for 10 weeks before delivery. Her age at presentation and the self-limited nature of cardiac sequelae with complete resolution of cardiac dysfunction suggest withdrawal effects from this exposure. Whereas the rebound hypertensive effects of α-adrenergic agonists are well established in the adult population, this report shows an unusual adverse outcome of in utero exposure to methyldopa.
Division of Cardiology, Department of Pediatrics, jsu@chla.usc.edu.
Jennifer A
JA
Su
Department of Pharmacy, and.
William
W
Tang
Division of Critical Care Medicine, Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California.
Niurka
N
Rivero
Division of Cardiology, Department of Pediatrics.
Yaniv
Y
Bar-Cohen
D000322:Adrenergic Agonists / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000139:chemically induced*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced*; D046110:Hypertension, Pregnancy-Induced / Q000188:drug therapy*; D007231:Infant, Newborn; D008750:Methyldopa / Q000009:adverse effects* / Q000627:therapeutic use*; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis*
D000322:Adrenergic Agonists; D008750:Methyldopa
heart failure; hypertension; methyldopa; newborn; withdrawal