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Severe pulmonary hypertension with therapeutic L-lysine ibuprofen in 2 preterm neonates

Barbara Amendolia1, Madeline Lynn, Vishwanath Bhat

  • 1Department of Pediatrics, Cooper University Hospital, Camden, New Jersey 08103, USA. amendolia-barbara@cooperhealth.edu

Pediatrics
|April 12, 2012
PubMed

Insights

Ibuprofen, used to treat patent ductus arteriosus (PDA) in premature infants, can rarely cause severe pulmonary hypertension. This serious complication occurred in two infants, highlighting the need for careful monitoring during PDA treatment.

Area of Science:

  • Neonatology
  • Pediatric Cardiology
  • Pharmacology

Background:

  • Patent ductus arteriosus (PDA) is common in very low birth weight infants, leading to significant morbidity.
  • Ibuprofen is increasingly preferred over indomethacin for PDA closure due to lower risk of necrotizing enterocolitis.
  • Pulmonary hypertension is a rare but severe complication associated with ibuprofen therapy.

Observation:

  • Two preterm infants developed severe pulmonary hypertension after receiving L-lysine ibuprofen for PDA closure.
  • Both infants presented with echocardiographic evidence of increased pulmonary vascular resistance and left-to-right shunting.
  • Clinical deterioration, including refractory hypotension and hypoxemia, occurred within 48-72 hours.

Findings:

  • The infants' conditions rapidly worsened, with repeat echocardiograms confirming severe pulmonary hypertension.
  • Despite therapeutic interventions, both infants ultimately died from complications related to pulmonary hypertension.
  • This suggests a potential causal link between L-lysine ibuprofen and the development of pulmonary hypertension in susceptible preterm infants.

Implications:

  • Clinicians must be aware of the potential for severe pulmonary hypertension as a complication of ibuprofen therapy for PDA.
  • Careful echocardiographic monitoring for pulmonary hypertension is crucial in preterm infants receiving ibuprofen.
  • Further research is needed to understand the mechanism and identify risk factors for ibuprofen-induced pulmonary hypertension.

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