Two cases suggesting a role for the L–arginine nitric oxide pathway in neonatal blood pressure regulation

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Abstract
Endogenous nitric oxide produced from L–arginine is a potent vasodilator that may be involved in blood pressure regulation. A male infant with argininosuccinate lyase deficiency, who could not synthesize L–arginine, was hypertensive prior to L–arginine replacement. The infusion of L–arginine resulted in a decrease in blood pressure. A three–fold increase in the dose of L–arginine further decreased blood pressure. On discontinuing the infusion of L–arginine, the patient's blood pressure increased. A female infant undergoing an L–arginine challenge test had a decrease in blood pressure during L–arginine infusion which resolved when the L–arginine infusion was discontinued. These two cases suggest that nitric oxide production from L–arginine may play a role in the normal regulation of systemic blood pressure.