2009 Southern Regional Meeting Abstracts

Case Report: The use of angiotensin converting enzyme (ACE) inhibitors in children and young adults has increased over the past decade. Second and third trimester ACE inhibitor use to significant fetopathy is well established. We present the case of an estimated 34 week gestation newborn female born to a 32 year old mother who had no prenatal care. Despite aggressive management of respiratory failure, pulmonary hypertension, and anuria, severe hypoxemia progressed. The mother provided a history of chronic hypertension which had been treated with a combination of medications including the ACE inhibitor benezepril. An echocardiogram revealed right to left flow through the ductus arteriosus and diastolic reversal of blood flow in the aortic arch. A chest X-ray suggested pulmonary hypoplasia. The baby expired at 22 hours of age. This case demonstrates the potential deleterious effects of maternal ACE inhibitor use during pregnancy and the importance of patient education. The reversal of blood flow in the aortic arch was an unusual finding. Flow reversal in the arch has been associated with poor prognosis in newborns with pulmonary hypertension and is explained in this patient by severe pulmonary hypoplasia.