Hypertension in a preterm after indomethacin use for patent ductus arteriosus

Abstract

Hypertension is a known complication of non-steroidal antiinflammatory drugs (NSAIDs) in adults1). However, it has rarely been reported in children. In a retrospective study of neonates diagnosed with hypertension, indomethacin treatment for patent ductus arteriosus (PDA) was described to be associated with the development of hypertension2). It is reported that medical PDA closure is usually associated with an increase in systemic blood pressure3). The clinical course and laboratory findings of such cases, however, have not been described. We report a preterm infant who developed hypertension after the administration of indomethacin for PDA. Although our case had preceding acute kidney injury (AKI) due to indomethacin, hypertension developed after urine output started to increase. While NSAID-induced hypertension in adults has been ascribed to renal vasoconstriction and subsequent sodium retention4), the major mechanism of hypertension in our case was thought to be high after load due to increased vascular resistance, presumably induced by the inhibition of vascular prostaglandin I2 (PGI2) synthesis. Case Report