From the Research
Captopril should be avoided in premature infants and neonates due to its potential association with necrotizing enterocolitis (NEC). The most recent and highest quality study on NEC, published in 2022 1, highlights the importance of careful antibiotic treatment in managing NEC, but does not directly address the use of captopril. However, the link between captopril and NEC appears related to its effects on intestinal blood flow regulation, as it inhibits angiotensin II production, leading to reduced mesenteric perfusion pressure and altered intestinal blood flow autoregulation in the immature gut of premature infants 2. This hemodynamic compromise may contribute to intestinal ischemia and subsequent development of NEC. Additionally, captopril's rapid onset of action can cause abrupt blood pressure changes that may further compromise intestinal perfusion.
When treating neonates with cardiovascular conditions requiring ACE inhibition, careful monitoring of blood pressure, renal function, and abdominal symptoms is essential regardless of which agent is used, with treatment initiated at the lowest effective dose and gradually titrated while monitoring for signs of intestinal compromise. Alternative medications such as enalapril or lisinopril may be preferred if ACE inhibitor therapy is necessary for conditions like hypertension or heart failure in neonates. The use of antibiotics in NEC treatment is crucial, and studies such as the one published in 2020 3 suggest that narrow-spectrum and shorter course NEC treatment may be preferred to minimize adverse effects.
Key considerations in managing NEC include:
- Careful antibiotic treatment
- Monitoring for signs of intestinal compromise
- Avoiding captopril in premature infants and neonates
- Using alternative ACE inhibitors if necessary
- Initiating treatment at the lowest effective dose and gradually titrating
- Considering the potential benefits of narrow-spectrum and shorter course antibiotic treatment.