2-008 | Additional Comments | Previous Article | Next Article | List of Articles | Submit Comments | Index | FSN Home Page
Maternal NSAIDs and PPHN
Analysis of Nonsteroidal Antiinflamatory Drugs in Meconium and its Relation to Persistent Pulmonary Hypertension of the Newborn. Alano AA, Ngougmna E, Ostrea EM, et al. Pediatrics Mar 2001; 107:519-23.
In a case-control study, meconium was collected from 101 newborn infants (40 with PPHN and 61 healthy term controls), and analyzed for NSAIDs (ibuprofen, naproxin, indomethacin and aspirin). The diagnoses associated with PPHN were primary PPHN (25%), meconium aspiration syndrome (35%), RDS (20%), low apggar score/asphyxia (12.5%), and pneumonia/sepsis (8%). The mean duration of ventilator support for the PPHN group was 11 days. Nitric oxide was ggiven to 19 infants (47.5%) for a mean duration of 25.4 hours. 14 of the 19 infants who were treated with iNO (74%) required ECMO, and 2 died. The overall incidence of positive NSAIDs in meconium in the study population (n=101) was 49.5%. There was poor association between maternal history of NSAID use and NSAID detection in meconium. PPHN was significantly associated with the presence of at least 1 NSAID in meconium (odds ratio = 21.47; 95% CI = 7.12 – 64.71). By logistic regression analysis, antenatal exposure to aspirin, naproxin, and ibuprofen were significantly associated with PPHN, and treatment with iNO or ECMO.
Comment. It appears that maternal treatment with NSAIDs during pregnancy poses a significant risk for the development of PPHN in her baby. This is presumably due to fetal ductal closure resulting in increased pulmonary blood flow and subsequent pulmonary vascular changes. While this association between NSAIDs and PPHN is not new, it was notable that nearly 50% of the babies studied had positive meconium tests for NSAIDs, We need a campaign to educate pregnant women of the dangers of NSAIDs for their babies