Article Text
Summary
We present a 30+2-weeks-old (30 weeks and 2 days) male, twin 1, born by emergency caesarean section due to twin-twin transfusion syndrome (absent end-diastolic flow and cardiac anomaly in twin 2) presenting with hypertensive crisis on day 3. He was already on milrinone and propranolol. His echocardiogram showed poor left ventricular contractility and after cardiology consultation received sodium nitroprusside, which eventually saved his life by decreasing his blood pressure and improving cardiac function. As sodium nitroprusside is very rarely used for hypertensive crisis in neonates, we would like to share our experiences on dosage, challenges in administration due to its fast onset of action, criteria for monitoring for complications and finally weaning. Baby developed severe bilateral periventricular leukomalacia as a potential complication of hypertensive crisis, preceded by bilateral periventricular flare secondary to twin-twin transfusion.
- heart failure
- cardiovascular system
- paediatrics (drugs and medicines)
- neonatal intensive care
- therapeutic indications
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Footnotes
AGD and PBJS contributed equally.
Contributors AGD and PBJS were both involved very closely in observing baby vitals closely and delivering treatment, collecting patient consent, primary Pubmed search to find out more about sodium nitro prusside drug and relevant publications, collecting and reviewing case reports. PBJS was involved in writing the initial script. Discussion and references were discussed with JL until finalisation. OF specialist cardiology input regarding treatment and further management. JL supervised overall treatment and gave guidance to finalise the case report and to the final editing.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors
Competing interests None declared.
Patient consent Parent consent obtained.
Provenance and peer review Not commissioned; externally peer reviewed.