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Arginine Prevents NEC?
Arginine supplementation prevents necrotizing enterocolitis in the premature infant. Amin HJ, Zamora SA, McMillan DD, et al. J Pediatr
(April 2002);140:425-31.Objectives: To determine whether supplementation with L-arginine reduces the incidence of all stages of necrotizing enterocolitis (NEC) in premature infants with birth weight <1250 g and gestational age <32 weeks.
Study design: In a randomized, double-blind, placebo-controlled study, 152 premature infants were prospectively, randomly assigned to receive either supplemental L-arginine (1.5 mmol/kg per day; n =75 [group A]) or placebo (control group; n = 77 [group B]) with oral feeds/parenteral nutrition during the first 28 days of life. Nutrient intake, plasma ammonia, arginine, and amino acid concentrations were measured in all infants at days 3, 14, and 28 and at the time of diagnosis of NEC.
Results: NEC developed in 5 infants in group A compared with 21 infants in group B (P< .001). Arginine intake and plasma arginine concentrations were similar in both groups at study entry and (as expected) increased in group A at days 14 and 28. Plasma arginine concentrations were lower in both groups at time of diagnosis of NEC. No significant differences in maternal and neonatal demographics, nutrient intake, plasma ammonia and total and essential amino acid concentrations were present between the two groups.
Conclusions: Arginine supplementation (1.5 mmol/kg per day) in premature infants reduces the incidence of all stages of NEC.
Comment. The authors postulate that arginine prevents NEC by increasing gut blood flow through activation of nitric oxide synthesis in GI endothelial cells. The study looks at all stages of NEC, including stage I disease which has no strict diagnostic criteria. If only patients with Bell’s stage II or III are considered, the results only approach statistical significance (p = 0.09). I am also bothered by the relatively high incidence of NEC in the placebo group (27%). It remains to be seen whether the beneficial effects of arginine supplementation will also be seen in NICUs with a more typical incidence of NEC. ABK
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