Reduced serum amino acid concentrations in infants with necrotizing enterocolitis

Arginine supplementation prevents necrotizing enterocolitis in the premature infant

OBJECTIVES

To determine whether supplementation with L -arginine reduces the incidence of all stages of necrotizing enterocolitis (NEC) in premature infants with birth weight < or =1250 g and gestational age < or =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.

Update on host defense and immunonutrients

Neonatal intensive care in the past three decades has provided exciting modalities for improving the survival of critically ill neonates. There remains a great need for improving the quality of life for these survivors. In this article, the role the developing GI tract and its microenvironment play in the well-being of the neonate has been emphasized. Future therapies based on manipulation of the GI tract and its microenvironment by functional foods, immunonutrients, or pharmacologic agents may have effects not only during the neonatal period, but also throughout the individual's entire life.