Korean J Perinatol.  2012 Dec;23(4):292-297.

Persistent Pulmonary Hypertension of the Newborn in a Preterm Infant Exposed to Methotrexate During the Early Gestational Period

• Suh YE
• Lee BS
• Kim JJ
• Won HS
• Lim G
• Choi YS
• Kim EA
• Kim KS

Abstract

Methotrexate (MTX) is used in the reproductive aged females for the management of medical conditions such as ectopic pregnancy, autoimmune diseases and malignancies. Because of its antimetabolite effect, exposure to MTX during the fetal period can cause multiple anomalies. The most common anomalies related to intrauterine MTX exposure include growth retardation, craniofacial dysmorphism, central nervous system anomalies, cardiac anomalies and skeletal defects. We report a premature baby boy born after 27(+5) weeks of gestation who presented intrauterine growth restriction, single umbilical artery, small chest and anomalies of rib and thoracic vertebra. His mother had received 50 mg of MTX for the treatment of misdiagnosed ectopic pregnancy at 5th week of gestation. During the hospitalization, he was ventilator dependent and pulmonary hypertension persisted despite medical treatment including nitric oxide and sildenafil. Open lung biopsy revealed nonspecific findings suggestive of lung hypoplasia. He died at 141 days after birth due to respiratory failure.

Keyword

Methotrexate; Congenital anomalies; Pulmonary hypoplasia; Persistent pulmonary hypertension of the newborn

MeSH Terms

Aged
Autoimmune Diseases
Biopsy
Central Nervous System
Female
Hospitalization
Humans
Hypertension, Pulmonary
Infant, Newborn
Infant, Premature
Lung
Methotrexate
Mothers
Nitric Oxide
Parturition
Piperazines
Pregnancy
Pregnancy, Ectopic
Purines
Respiratory Insufficiency
Ribs
Single Umbilical Artery
Spine
Sulfones
Thorax
Ventilators, Mechanical
Sildenafil Citrate
Methotrexate
Nitric Oxide
Piperazines
Purines
Sulfones