A Rare and Unusual Case of Severe Persistent Pulmonary Hypertension in a Newborn due to Accidental Drug Exposure in Mother

Mahaveer Singh Lakra; Amar Taksande; Ashwini Lakra; Rewat Meshram; Roshan Prasad

doi:10.54133/ajms.v7i2.1510

Authors

Mahaveer Singh Lakra Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education Research, Sawangi, Meghe, Wardha, Maharashtra, India
Amar Taksande Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education Research, Sawangi, Meghe, Wardha, Maharashtra, India
Ashwini Lakra Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education Research, Sawangi, Meghe, Wardha, Maharashtra, India
Rewat Meshram Department of Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education Research, Sawangi, Meghe, Wardha, Maharashtra, India
Roshan Prasad Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education Research, Sawangi, Meghe, Wardha, Maharashtra, India https://orcid.org/0000-0002-1958-2026

DOI:

https://doi.org/10.54133/ajms.v7i2.1510

Keywords:

Maternal drug exposure, Maternal depression, New borne, Persistent pulmonary hypertension, Serotonin reuptake inhibitors, Vascular remodeling

Abstract

Persistent pulmonary hypertension is a life-threatening illness that can be fatal if not diagnosed early. Some medications, notably selective serotonin reuptake inhibitors (SSRIs), can cause severe persistent pulmonary hypertension in newborns if administered antenatally, especially after 20 weeks of gestation. We present a case in which the use of selective serotonin uptake inhibitors during pregnancy resulted in severe chronic pulmonary hypertension in a newborn. A 2.5-kilogram male newborn was delivered via caesarean section and was asymptomatic for one day. On day 2 of life, the baby suffered cyanosis and difficulties breathing, necessitating intubation. In retrospect, the mother was taking sertraline for the treatment of depression. Based on the clinical characteristics and presentation, an echocardiogram was performed, which revealed severe chronic pulmonary hypertension. The baby was successfully treated with pulmonary vasodilators and high flow oscillating ventilation.

Downloads

Download data is not yet available.

References

Teng RJ, Wu TJ. Persistent pulmonary hypertension of the newborn. J Formos Med Assoc. 2013;112(4):177-184. doi: 10.1016/j.jfma.2012.11.007. DOI: https://doi.org/10.1016/j.jfma.2012.11.007

Delaney C, Cornfield DN. Risk factors for persistent pulmonary hypertension of the newborn. Pulm Circ. 2012;2(1):15-20. doi: 10.4103/2045-8932.94818. DOI: https://doi.org/10.4103/2045-8932.94818

Andrade SE, McPhillips H, Loren D, Raebel MA, Lane K, Livingston J, Boudreau DM, Smith DH, Davis RL, Willy ME, Platt R. Antidepressant medication use and risk of persistent pulmonary hypertension of the newborn. Pharmacoepidemiol Drug Saf. 2009 Mar;18(3):246-52. DOI: https://doi.org/10.1002/pds.1710

Ng QX, Venkatanarayanan N, Ho CYX, Sim WS, Lim DY, Yeo WS. Selective serotonin reuptake inhibitors and persistent pulmonary hypertension of the newborn: An update meta-analysis. J Womens Health (Larchmt). 2019;28(3):331-338. doi: 10.1089/jwh.2018.7319. DOI: https://doi.org/10.1089/jwh.2018.7319

Huybrechts KF, Bateman BT, Palmsten K, Desai RJ, Patorno E, Gopalakrishnan C, et al. Antidepressant use late in pregnancy and risk of persistent pulmonary hypertension of the newborn. JAMA. 2015;313(21):2142-2151. doi: 10.1001/jama.2015.5605. DOI: https://doi.org/10.1001/jama.2015.5605

Arshad MS, Adnan M, Anwar-Ul-Haq HM, Zulqarnain A. Postnatal causes and severity of persistent pulmonary hypertension of newborn. Pak J Med Sci. 2021;37(5):1387-1391. doi: 10.12669/pjms.37.5.2218. DOI: https://doi.org/10.12669/pjms.37.5.2218

Singh Y, Lakshminrusimha S. Pathophysiology and management of persistent pulmonary hypertension of the newborn. Clin Perinatol. 2021;48(3):595-618. doi: 10.1016/j.clp.2021.05.009. DOI: https://doi.org/10.1016/j.clp.2021.05.009

Sharma V, Berkelhamer S, Lakshminrusimha S. Persistent pulmonary hypertension of the newborn. Matern Health Neonatol Perinatol. 2015;1:14. doi: 10.1186/s40748-015-0015-4. DOI: https://doi.org/10.1186/s40748-015-0015-4

Bérard A, Sheehy O, Zhao JP, Vinet É, Bernatsky S, Abrahamowicz M. SSRI and SNRI use during pregnancy and the risk of persistent pulmonary hypertension of the newborn. Br J Clin Pharmacol. 2017;83(5):1126-1133. doi: 10.1111/bcp.13194. DOI: https://doi.org/10.1111/bcp.13194

Munk-Olsen T, Bergink V, Rommel A, Momen N, Liu X. Association of persistent pulmonary hypertension in infants with the timing and type of antidepressants in utero. JAMA Netw Open. 2021;4(12):e2136639. doi: 10.1001/jamanetworkopen.2021.36639. DOI: https://doi.org/10.1001/jamanetworkopen.2021.36639

Chambers CD, Hernandez-Diaz S, Van Marter LJ, Werler MM, Louik C, Jones KL, et al. Selective serotonin-reuptake inhibitors and risk of persistent pulmonary hypertension of the newborn. N Engl J Med. 2006;354(6):579-587. doi: 10.1056/NEJMoa052744. DOI: https://doi.org/10.1056/NEJMoa052744

Pawluski JL, Galea LA, Brain U, Papsdorf M, Oberlander TF. Neonatal S100B protein levels after prenatal exposure to selective serotonin reuptake inhibitors. Pediatrics. 2009;124(4):e662-670. doi: 10.1542/peds.2009-0442. DOI: https://doi.org/10.1542/peds.2009-0442

de Boode WP, Singh Y, Molnar Z, Schubert U, Savoia M, Sehgal A, et al. Application of neonatologist performed echocardiography in the assessment and management of persistent pulmonary hypertension of the newborn. Pediatr Res. 2018;84(Suppl 1):68-77. doi: 10.1038/s41390-018-0082-0. DOI: https://doi.org/10.1038/s41390-018-0082-0