FETAL EXPOSURE TO LISINOPRIL - NEONATAL MANIFESTATIONS AND MANAGEMENT

The use of angiotensin-converting enzyme (ACE) inhibitors in pregnancy has been associated with neonatal morbidity and mortality. The mechan ism of renal dysfunction likely is related to fetal hypotension and pr olonged decreased glomerular filtration. Six of 14 previously publishe d cases of neonatal renal failure after maternal ACE inhibitor therapy resulted in death. Eight infants survived after peritoneal dialysis, some with residual renal impairment. Serum lisinopril levels and ACE a ctivity in our patient indicate that during the anuric state the drug has an extremely prolonged half-life, and that it is removed by perito neal dialysis. In view of this prolonged half-life and the drug's cont inued suppression of ACE activity and renal function, we recommend ins titution of early dialysis in infants with renal failure after materna l therapy with lisinopril.