Prematurely closed arterial duct: possible risks for the newborn

Abstract

Premature closure of the fetal ductus arteriosus is a rare phenomenon that results in increased right ventricular pressure, leading to the development of isolated right ventricular hypertrophy, high pulmonary hypertension, and even death.

Purpose - to present a rare clinical case of prenatally closed ductus arteriosus in a newborn boy, that clinically manifested by severe respiratory failure immediately after birth.

Clinical case. The child was admitted to the neonatal intensive care unit 5 hours after delivery with clinical signs of severe respiratory failure, child was oxygen-dependent. 

It is known from the anamnesis that the child was delivered by urgent cesarean section on the basis of a prenatally diagnosed prematurely closed arterial duct. A week before the delivery, the mother had an acute respiratory viral infection accompanied by high fever, which was treated with high doses of over-the-counter ibuprofen.

The 2D echocardiography showed severe hypertrophy of the right ventricular wall and tricuspid insufficiency, which was caused by premature closure of the ductus arteriosus. The flow through the ductus arteriosus was not determined. Aortic coarctation as a possible cause of right ventricular hypertrophy in the newborn period was excluded.

The infant was switched to constant positive pressure artificial ventilation (CPAP) to reduce pulmonary vascular resistance and afterload of the right ventricle.

Over the next 3-4 weeks of oxygen therapy, the child's general condition improved significantly. Hypertrophy of the right ventricular wall regressed to normal size, the child grows and develops according to age.

Conclusions. Premature prenatal closure of the arterial duct can be idiopathic or caused drugs intake that suppress prostaglandin production late in the pregnancy. Pregnant women should be counseled about the potential side effects on the fetus caused by the use of NSAIDs, especially in the third trimester of pregnancy.

Urgent delivery and oxygen therapy contribute to the regression of intracardiac changes and significantly improve general condition of the child.

The study was conducted in accordance with the principles of the Declaration of Helsinki. The informed consent of the child’s parents was obtained for the study.

No conflict of interests was declared by the authors.