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The administration of non-steroidal antiinflammatory drugs (NSAID) has occasionally been related to fetal and neonatal cardiopulmonary, gastrointestinal, cerebral and renal complications. This report describes a term newborn with severe persistent pulmonary hypertension due to premature closure of the ductus arteriosus following a 5 day maternal treatment with diclofenac two weeks before delivery. Pulmonary hypertension only responded to unusually high doses of inhaled NO. The treatment was necessary for 22 days suggesting structural alteration of pulmonary vasculature. The child recovered, but tricuspid regurgitation persisted, presumably because of irreversible ischemic damage of one papillary muscle. This is the first reported case of persistent pulmonary hypertension of the newborn (PPHN) in association with maternal diclofenac treatment and represents a most severe form of PPHN induced by NSAID.
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