Fatal neonatal renal failure due to maternal enalapril ingestion

ACE inhibitors are commonly used drugs in the management of adult hypertension. However their use in pregnant women can have serious effects on the fetus. In this manuscript we report a case of fatal neonatal renal failure associated with maternal intake of enalapril during third trimester and review the related literature. CASE: The index case was born to a mother with PIH which was treated with enalapril (5 mg) once a day for 21 days prior to delivery in addition to other anti-hypertensives. Temporally, use of enalapril was associated with the onset of oligohydramnios. The neonate presented with intrauterine growth retardation, hydrops and oliguric renal failure, which did not respond to furosemide, peritoneal dialysis and exchange transfusion. Autopsy showed macroscopically and microscopically normal kidneys. CONCLUSION: Use of ACE inhibitors during pregnancy should be avoided.