Perforating gastric ulceration during tolazoline therapy for persistent foetal circulation

Area of Science:

• Neonatal medicine
• Pediatric pharmacology
• Gastroenterology

Background:

• Persistent fetal circulation (PFC) is a critical condition in neonates.
• Tolazoline is a vasodilator sometimes used to treat PFC.
• Gastric ulcerations are a potential complication in critically ill infants.

Observation:

• An infant diagnosed with persistent fetal circulation received tolazoline therapy.
• Gastric ulceration symptoms appeared 14 hours after initiating tolazoline.
• Abdominal free air, indicating perforation, was observed 34 hours post-treatment initiation.

Findings:

• The observed gastric ulcerations are potentially linked to tolazoline administration.
• This suggests a possible adverse drug reaction in the infant.
• The timing of symptom onset and perforation suggests a causal relationship.

Implications:

• Tolazoline's use in neonates warrants careful monitoring for gastrointestinal complications.
• Cimetidine may be a prophylactic agent to mitigate the risk of tolazoline-induced ulcerations.
• Further research is needed to confirm the safety profile of tolazoline in neonates.