Modern Pediatrics. Ukraine. (2023). 8(136): 124-129. doi: 10.15574/SP.2023.136.124
Malska A. A.¹, Kurilyak O. B.², Kurkevych A. K.³, Burak T. V.^4
1Danylo Halytsky Lviv National Medical University, Ukraine
²Clinical Center of Childrens’ Healthcare, Lviv, Ukraine
³Center of pediatric cardiology and cardiac surgery of the Ministry of Health of Ukraine, Kyiv
⁴Western Ukrainian Specialized Children’s Medical Centre, Lviv

For citation: Malska AA, Kurilyak OB, Kurkevych AK, Burak TV. (2023). Prematurely closed arterial duct: possible risks for the newborn. Modern Pediatrics. Ukraine. 8(136): 124-129. doi: 10.15574/SP.2023.136.124.
Article received: Sep 11, 2023. Accepted for publication: Dec 12, 2023.

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.
Keywords: patent ductus arteriosus, right ventricular hypertrophy, pulmonary hypertension, newborn.
REFERENCES

1. Battistoni G, Montironi R, Di Giuseppe J, Giannella L, Carpini GD, Baldinelli A et al. (2021). Foetal ductus arteriosus constriction unrelated to non-steroidal anti-Inflammatory drugs: a case report and literature review. Annals of Medicine. 53 (1): 860-873. https://doi.org/10.1080/07853890.2021.1921253; PMid:34096417 PMCid:PMC8189142

2. Choi EY, Li M, Choi CW, Park KH, Choi JY. (2013). A case of progressive ductal constriction in a fetus. Korean Circ J. 43(11): 774-781. https://doi.org/10.4070/kcj.2013.43.11.774; PMid:24363755 PMCid:PMC3866319

3. Chugh BD, Makam A. (2020). Diagnosis and management of fetal ductus arteriosus constriction. J Fetal Med. 7(3): 235-242. https://doi.org/10.1007/s40556-020-00266-3

4. Ishida H, Inamura N, Kawazu Y et al. (2011). Clinical features of the complete closure of the ductus arteriosus prenatally. Congenit Heart Dis. 6: 51-56. https://doi.org/10.1111/j.1747-0803.2010.00411.x; PMid:21269413

5. Ishida H, Kawazu Y, Kayatani F, Inamura N. (2016). Prognostic factors of premature closure of the ductus arteriosus in utero: a systematic literature review. Cardiol Young. 27(4): 634-638. https://doi.org/10.1017/S1047951116000871; PMid:27322829

6. Lopes LM, Carrilho MC, Francisco RP et al. (2016). Fetal ductus arteriosus constriction and closure: analysis of the causes and perinatal outcome related to 45 consecutive cases. J Matern Fetal Neonatal Med. 29: 638-645. https://doi.org/10.3109/14767058.2015.1015413; PMid:25708490

7. Nagasawa H, Hamada C, Wakabayashi M, Nakagawa Y, Nomura S, Kohno Y. (2016). Time to spontaneous ductus arteriosus closure in full-term neonates. Open Heart. 3(1): e000413. https://doi.org/10.1136/openhrt-2016-000413; PMid:27239325 PMCid:PMC4874051

8. Pedra SRFF, Zielinsky P, Binotto CN et al. (2019, Jun 6). Brazilian Fetal Cardiology Guidelines – 2019. Arq Bras Cardiol. 112(5): 600-648. https://doi.org/10.5935/abc.20190075; PMid:31188968 PMCid:PMC6555576

9. Rakha S. (2017). Excessive maternal orange intake – a reversible etiology of fetal premature ductus arteriosus constriction: a case report. Fetal Diagn Ther. 42(2): 158-160. https://doi.org/10.1159/000453063; PMid:28746929

10. Shima Y, Ishikawa H, Matsumura Y, Yashiro K, Nakajima M, Migita M. (2010). Idiopathic severe constriction of the fetal ductus arteriosus: a possible underestimated pathophysiology. Eur J Pediatr. 170(2): 237-240. https://doi.org/10.1007/s00431-010-1295-3; PMid:20845046

11. Sridharan S, Archer N, Manning N. (2009). Premature constriction of the fetal ductus arteriosus following the maternal consumption of chamomile herbal tea. Ultrasound Obstet Gynecol. 34: 358-359. https://doi.org/10.1002/uog.6453; PMid:19705407