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Coumarin embryopathy in an extremely low birth weight infant associated with neonatal hepatitis and ocular

Patrick G Hetzel1, René Glanzmann, Pascal W Hasler

  • 1Department of Neonatology, University Children's Hospital, Basel, Switzerland. patrick.hetzel@ukbb.ch

European Journal of Pediatrics
|January 18, 2006
PubMed

Insights

Prenatal exposure to vitamin K antagonists can cause Coumarin embryopathy (CE). This case highlights neonatal hepatopathy as a rare but serious CE manifestation, emphasizing cautious use during pregnancy.

Area of Science:

  • Medical Science
  • Neonatology
  • Toxicology

Background:

  • Coumarin embryopathy (CE) is a known condition resulting from prenatal exposure to vitamin K antagonists.
  • Vitamin K antagonists are often prescribed for pregnant women with mechanical heart valves.

Observation:

  • A premature infant (25 weeks' gestation) exposed to phenprocoumon in utero presented with typical CE features.
  • The infant exhibited impaired coagulation, cerebral hemorrhages, and midface hypoplasia.
  • Additionally, the infant developed prolonged neonatal hepatopathy, including conjugated hyperbilirubinemia, elevated liver enzymes, and hypoglycemia.

Findings:

  • This case is the first to describe neonatal hepatopathy as a component of Coumarin embryopathy.
  • Ocular abnormalities included corneal opacity, anterior segment dysgenesis, cataract, and persistent pupillary membrane.

Implications:

  • Neonatal hepatopathy is a significant, albeit uncommon, side effect of in utero vitamin K antagonist exposure.
  • Anticoagulation with vitamin K antagonists in pregnant women with mechanical heart valves requires extreme caution.

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