Advertisement

Indian Pediatrics

, Volume 56, Issue 10, pp 868–872 | Cite as

Severe Pulmonary Arteriopathy in a Neonate with Congenital Rubella Syndrome and Patent Ductus Arteriosus

  • Supreet Khurana
  • Akriti Bansal
  • Shiv Sajan SainiEmail author
  • Anand Mishra
  • Praveen Kumar
Clinicopathological Conference
  • 7 Downloads

Abstract

Neonates with congenital rubella syndrome (CRS) are known to have associated congenital cardiac malformations. Patent ductus arteriosus (PDA) is one the most common cardiac anomalies associated with CRS. PDA refractory to medical management and associated with ventilatory dependence is considered for surgical ligation. However, the management of PDA can be challenging in the presence of underlying lung disease or pulmonary vascular disease. Outcomes after closure in neonates are dependent upon age, weight, nutritional status, pre-operative pulmonary arterial hypertension and presence of chronic lung disease. We present a neonate with CRS who required surgical PDA closure. The neonate developed severe pulmonary arterial hypertension which led to fatal outcome. The clinical course is corroborated with histo-pathological changes observed on the autopsy of this neonate.

Keywords

Complications Epidemiology German measles Pregnancy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Notes

Acknowledgements

Prof Ashim Das for conducting autopsy, providing us with essential information regarding histopathological findings and modification and approval of pathology protocol.

Funding: None; Competing interest: None stated.

References

  1. 1.
    World Health Organization; WHO 2014. WHO-recommended Surveillance Standard of Rubella and Congenital Rubella Syndrome: Available from http://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/rubella_standards/en. Accessed December 11, 2017.
  2. 2.
    Mace M, Cointe D, Six Caroline, Levy-Bruhl D, Chatelet IP, Ingrand D, et al. Diagnostic value of Reverse Transcription- PCR of amniotic fluid for prenatal diagnosis of congenital rubella infection in pregnant women with confirmed primary rubella infection. J Clin Microbiol. 2004;42:4818–20.CrossRefGoogle Scholar
  3. 3.
    Niu MC, Mallory GB, Justino H, Ruiz FE, Petit CJ. Treatment of severe pulmonary hypertension in the setting of the large patent ductus arteriosus. Pediatrics. 2013;131:e1643–49.CrossRefGoogle Scholar
  4. 4.
    Bhalgat PS, Pinto R, Dalvi VB. Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension: Short and intermediate term results. Ann Pediatr Cardiol. 2012;5:135–40.CrossRefGoogle Scholar
  5. 5.
    Guzeltas A, Eroglu GA. Reference values for echocardiographic measurements of healthy newborns. Cardiol Young. 2012;22:152–7.CrossRefGoogle Scholar
  6. 6.
    Murhekar M, Bavdekar A, Benakappa A, Santhanam S, Singh K, Verma S, et al. Sentinel surveillance for congenital rubella syndrome- India, 2016–17. MMWMR Morb Mortal Wkly Rep. 2018;67:1012–6.CrossRefGoogle Scholar
  7. 7.
    Singh MM. Need for rubella vaccination in India. BMJ. 2014;349:g4844.CrossRefGoogle Scholar
  8. 8.
    World Health Organization. WHO 2018. Global and Regional Immunization Profile South-East Asia Region. Available from: http://www.who.int/immunization/monitoring_surveillance/data/gs_searprofile.pdf. Accessed November 3, 2018.
  9. 9.
    Lanzieri T, Redd S, Abernathy E, Icenogle J. Congenital Rubella Syndrome. Centers for Disease Control and Prevention 2018. Available from: https://www.cdc.gov/vaccines/pubs/surv-manual/chpt15-crs.html. Accessed December 12, 2018
  10. 10.
    Dobson RS, Edwards SM, Weisman LE, Armsby C. Uptodate 2018. Congenital Rubella Syndrome: Clinical Features and Diagnosis. Available from: https://www.uptodate.com/contents/congenital-rubella-syndrome-clinical-features-and-diagnosis. Accessed December 12, 2018.
  11. 11.
    Rao JN, Chancham S, Reddy UN, Nagasravani J, Mazher N, Mustafa ST. Congenital rubella syndrome with basal ganglia calcification and bilateral nuclear cataracts in a neonate: A rare entity. Sch J Med Case Rep. 2014;2:470–2.Google Scholar
  12. 12.
    Eckstein M, Vijayalakshmi P, Killedar M, Gilbert C, Foster A. Etiology of childhood cataract in south India. Br J Ophthalmol. 1996;80:628–32.CrossRefGoogle Scholar
  13. 13.
    Numazaki K, Fujikawa T. Intracranial Calcifications with congenital rubella syndrome in a mother with serological immunity. J Child Neurol. 2003;18:296–7.CrossRefGoogle Scholar
  14. 14.
    Cherry JD, Adachi K. Rubella virus. In: Cherry JD, Harrison GJ, Kaplan SL, editors. Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th ed, Philadelphia: Elsevier Saunders, 2014. P. 2195.Google Scholar
  15. 15.
    Plotkin SA, Reef SE, Cooper LS, Alford CA. Rubella. In: Remington, JS, Klein, JO, Wilson, CB, editors, Infectious Diseases of the Fetus and Newborn Infant, 7th ed, Philadelphia: Elsevier Saunders, 2011. P. 861.CrossRefGoogle Scholar
  16. 16.
    Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, et al. Management of patent ductus arteriosus. Circulation. 2008;118:e714.PubMedGoogle Scholar
  17. 17.
    Rigby ML. Closure of a large patent ductus arteriosus in adults: first do no harm. Heart. 2007;93:417.CrossRefGoogle Scholar
  18. 18.
    Zhang DZ, Zhu XY, Lv B, Cui CS, Han XM, Sheng XT, et al. Trial occlusion to assess the risk of persistent pulmonary arterial hypertension after closure of a large patent ductus arteriosus in adolescents and adults with elevated pulmonary artery pressure. Circ Cardiovasc Interv. 2014;7:473–81.CrossRefGoogle Scholar
  19. 19.
    Yan C, Zhao S, Jiang S, Xu Z, Huang L, Zheng H, et al. Transcatheter closure of patent ductus arteriosus with severe pulmonary arterial hypertension in adults. Heart. 2007;93:514–8.CrossRefGoogle Scholar
  20. 20.
    Waleh N, Mccurnin CD, Yoder AB, Shaul PW, Clyman RI. Patent ductus arteriosus ligation alters pulmonary gene expression in preterm baboons. Pediatr Res. 2011;69:212–6.CrossRefGoogle Scholar
  21. 21.
    Niu MC, Mallory GB, Justino H, Ruiz FE, Petit CJ. Treatment of severe pulmonary hypertension in the setting of the large patent ductus arteriosus. Pediatrics 2013;131:e1643–49.CrossRefGoogle Scholar

Copyright information

© Indian Academy of Pediatrics 2019

Authors and Affiliations

  • Supreet Khurana
    • 1
  • Akriti Bansal
    • 2
  • Shiv Sajan Saini
    • 1
    Email author
  • Anand Mishra
    • 3
  • Praveen Kumar
    • 1
  1. 1.Division of Neonatology, Department of PediatricsPost Graduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of PathologyPost Graduate Institute of Medical Education and ResearchChandigarhIndia
  3. 3.Department of Cardiothoracic Vascular SurgeryPost Graduate Institute of Medical Education and ResearchChandigarhIndia

Personalised recommendations