Coronary artery dilatation in neonates: A novel case series

BackgroundCoronary artery dilatation (CAD) in neonates is an uncommon but clinically important finding on echocardiography. Reported associations include multisystem inflammatory syndrome in the newborn (MIS-N) following COVID-19 infection, congenital cardiac malformations, and perinatal inflammatory states. In the post-COVID era, CAD has been reported more frequently.MethodsThis retrospective, record-based case series conducted at a Government Medical College in South India describes the clinical profile of neonates with CAD who were admitted between January 2023 and December 2024.ResultsA total of 24 neonates with CAD were identified during the study period. They were admitted in NICU for different conditions like respiratory distress syndrome, congenital pneumonia, sepsis, or perinatal asphyxia. The mean (SD) gestational age was 35.5 (2.2) weeks, and the mean birth weight was 2557 (646) g. Respiratory distress was the most common presenting feature (95.8%) followed by shock (75%). CAD was detected incidentally during echocardiography which was performed to evaluate persistent pulmonary hypertension of the newborn (PPHN), assess ventricular dysfunction during shock, and exclude congenital heart disease, particularly in those with an unexpected clinical course. One-third of the neonates (n = 8) met the diagnostic criteria for MIS-N and all of them responded to intravenous immunoglobulin therapy, with no mortality. Mortality was 31.25% (n = 5) among the others. Complete resolution of coronary dilatation was observed in all infants within 3-6 months.ConclusionAssessment of coronary arteries for dilatation should be considered in any sick neonate with an inadequate response to conventional management. It may be a pointer for MIS-N.