L-citrulline supplementation in the treatment of pulmonary hypertension associated with bronchopulmonary dysplasia in preterm infant: A case report

INTRODUCTION: the aim of this case report is to present that oral L-citrulline supplementation may attenuate chronic pulmonary hypertension and reduce oxygen requirement in infants with severe bronchopulmonary dysplasia. IMPORTANT CLINICAL FINDINGS: a boy, with a birth weight of 700 g, born by cesarean section after 25 weeks of pregnancy complicated with preeclampsia, was admitted to the neonatal intensive care unit. He was ventilatory dependent for the next 3 months with significantly increased oxygen requirements. A severe stage of bronchopulmonary dysplasia, complicated with increased pulmonary vascular resistance, was diagnosed. Treatment with inhaled nitric oxide and oral sildenafil was included in the therapy of chronic pulmonary hypertension. The results of screening echocardiograms and increased plasma brain natriuretic peptide concentrations, suggested right ventricle dysfunction. THE MAIN INTERVENTION: at the beginning of the sixth month of hospitalization, oral supplementation of L-citrulline in a single dose of 150 mg/kg/day was introduced and continued for 70 days. During the first 3 weeks after L-citrulline was started, the patient was weaned from mechanical ventilation and he was never intubated again until he was discharged. Plasma brain natriuretic peptide concentrations decreased significantly during the first month of L-citrulline administration and became stable until the termination of L-citrulline supplementation. At discharge, the patient required 22%–25% concentration of oxygen supplemented intermittently, exclusively during feeding. CONCLUSION: these results indicate that L-citrulline supplementation may deserve coverage as an additional, potentially beneficial alternative in the prophylaxis or therapy of chronic pulmonary hypertension in newborns.