ABSTRACT
The main prostaglandin inhibitors to which neonates are exposed, either by transplacental passage, through breast milk, or by direct administration, are aspirin, indomethacin, and acetaminophen. Other antiprostaglandin agents such as indomethacin have demonstrated better activity in the treatment of patent ductus arteriosus and are exclusively used when pharmacologic therapy is indicated. Primary pulmonary hypertension characterized by inappropriately high pulmonary vascular resistance with subsequent right-to-left shunting of blood has been reported in two neonates whose mothers received indomethacin rectally and orally to inhibit premature labor. The results of pharmacokinetic analysis indicate that neonates metabolize aspirin in virtually the same way as adults. The popularity of aspirin as a nonnarcotic analgesic, many neonates are exposed to aspirin in utero which leads to subsequent difficulties during labor and delivery and toxicity during the neonatal period. The implications of aspirin crossing the placenta with subsequent measurable neonatal serum levels are substantial.
