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Side effects of angiotensin converting enzyme inhibitor (captopril) in newborns and young infants

Gantenbein, Monika Herbst ; Bauersfeld, Urs ; Baenziger, Oskar ; Frey, Bernhard ; Neuhaus, Thomas ; Sennhauser, Felix ; Bernet, Vera

In: Journal of Perinatal Medicine, 2008, vol. 36, no. 5, p. 448-452

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    Title
    • Side effects of angiotensin converting enzyme inhibitor (captopril) in newborns and young infants
    Author
    • Gantenbein, Monika Herbst. Department of Intensive Care and Neonatology, University Children's Hospital Zurich, Switzerland
    • Bauersfeld, Urs. Department of Cardiology, University Children's Hospital Zurich, Switzerland
    • Baenziger, Oskar. Department of Intensive Care and Neonatology, University Children's Hospital Zurich, Switzerland
    • Frey, Bernhard. Department of Intensive Care and Neonatology, University Children's Hospital Zurich, Switzerland
    • Neuhaus, Thomas. Department of Nephrology, University Children's Hospital Zurich, Switzerland
    • Sennhauser, Felix. Department of Pediatrics, University Children's Hospital Zurich, Switzerland
    • Bernet, Vera. Department of Intensive Care and Neonatology, University Children's Hospital Zurich, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • Journal of Perinatal Medicine, 2008, vol. 36, no. 5, p. 448-452. Walter de Gruyter
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:289937
    Summary
    Aim: To analyze the side effects of captopril, an angiotensin converting enzyme inhibitor (ACEI) in newborn and young infants. Methods: Retrospective analysis of side effects in 43 patients with congenital heart disease after cardiac surgery treated with captopril for heart failure during a two-year period. Results: Median age of the patients was 26days (range 6-310days), median weight 3.5kg (range 1.9-7.9kg). Initial median dose of captopril was 0.17 mg/kg/day (range 0.05-0.55mg/kg/day), slowly increased over 3-33days to a maximal median dose of 1.86 mg/kg/day (range 0.2-2.3mg/kg/day). All patients were additionally treated with diuretics. Side effects occurred in 17 patients (renal impairment or failure in 6, low blood pressure in 8, and oxygen saturation deficit in 3) requiring cessation or interruption in seven patients with renal impairment/failure (n=4), hypotension (n=1) and aorto-pulmonary shunting with low pulmonary perfusion (n=2). The six children who developed renal impairment or failure did so following a median delay of nine days after reaching the final dose and weighed on average 500g less than the other patients (P=0.046). All side effects were fully reversible. Conclusion: Side effects due to captopril were not dose-related in newborns and infants in this study. However, renal side effects occurred more often in smaller infants. Routine monitoring of infants on ACEI should include renal function tests, blood pressure and transcutaneous oxygen saturation measurements