We report on a term neonate with unexplained respiratory distress, dilatation of the descending aorta, and low serum retinol concentration. The respiratory distress did not respond to conventional medical management and persisted for 22 days requiring an inspired oxygen fraction of 0.4 to 0.5 to maintain adequate arterial oxygen saturation. One week after intramuscular vitamin A therapy, the respiratory distress and requirement for supplementary oxygen resolved. Dilatation of the distal aorta resolved at 7 weeks of age. An association between vitamin A deficiency and aortic dilatation has previously been described in rats, but the association in humans has rarely been reported. We suggest that unexplained neonatal respiratory distress and a dilated aorta should prompt suspicion of vitamin A deficiency. An underlying infective or inflammatory process may give rise to a falsely low serum retinol concentration. Serum retinol and retinol binding protein concentrations in both the mother and infant should be used to guide vitamin A status, treatment, and subsequent response.
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Case Report|
May 01 2015
Neonatal Aortic Dilatation Secondary to Vitamin A Deficiency
Rephainah Mallett, BSc(Hons);
Rephainah Mallett, BSc(Hons)
aSouthampton General Hospital, Hampshire, United Kingdom;
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Shanique Simmonds, BSc(Hons);
Shanique Simmonds, BSc(Hons)
bKings College London, Strand, London, United Kingdom;
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Abirami Kuppurajan, MRCPCH (UK);
Abirami Kuppurajan, MRCPCH (UK)
cWomen’s Center Hospitals, Coimbatore, India; and
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Arul Narayanan, FRCPCH;
Arul Narayanan, FRCPCH
dNarayana Hrudayalaya Hospital, Bangalore, India
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Karthik Balasubramanian, MBBS;
Karthik Balasubramanian, MBBS
cWomen’s Center Hospitals, Coimbatore, India; and
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Santhanakrishnan Ramakrishnan, MBBS
cWomen’s Center Hospitals, Coimbatore, India; and
Address correspondence to Santhanakrishnan Ramakrishnan, MBBS, MRCPCH (UK), DCH (UK), Head of the Department and Consultant Neonatologist, Women’s Center Hospitals, 146 B, Mettupalayam Rd, Coimbatore 641043, India. E-mail: ramkris@mac.com
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Address correspondence to Santhanakrishnan Ramakrishnan, MBBS, MRCPCH (UK), DCH (UK), Head of the Department and Consultant Neonatologist, Women’s Center Hospitals, 146 B, Mettupalayam Rd, Coimbatore 641043, India. E-mail: ramkris@mac.com
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
Pediatrics (2015) 135 (5): e1321–e1325.
Article history
Accepted:
January 29 2015
Citation
Rephainah Mallett, Shanique Simmonds, Abirami Kuppurajan, Arul Narayanan, Karthik Balasubramanian, Santhanakrishnan Ramakrishnan; Neonatal Aortic Dilatation Secondary to Vitamin A Deficiency. Pediatrics May 2015; 135 (5): e1321–e1325. 10.1542/peds.2014-3028
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