Blood Glucose, Serum Insulin and Glucagon Response to Arginine in Premature Infants

Abstract

The effect of arginine infusion on the peripheral blood sugar, plasma insulin and plasma glucagon was studied in 28 appropriate-for-gestational-age premature newborn infants, 1-day-old, and in 12 normal children 4–10 years old. In the premature plasma insulin and glucagon concentrations increased after arginine though less noticeably than in the older children, and their insulin/glucagon molar ratio was low at fasting and did not change after arginine. It is assumed that the endocrine pancreatic activity is already developed at birth and adequate to the metabolic state in neonatal life.

Plasma Arginine Levels and Blood Glucose Control in Very Preterm Infants Receiving 2 Different Parenteral Nutrition Regimens

“…No study has included infants <29 weeks’ gestation, investigated effects of sustained arginine infusion, or investigated the effects of arginine on postnatal hyperglycemia. However, there is evidence that hyperglycemia potentiates the effect of arginine on insulin secretion in newborn infants 17 . This may explain why our study showed a stronger association between arginine and blood glucose levels in the higher carbohydrate intake group.…”

“…Arginine is a powerful stimulus of β‐cell secretion. Several studies 14 – 17 report an increase in the plasma insulin concentration when arginine is administrated by an IV bolus over 30 minutes in term and preterm infants. The magnitude of the response depends on dose 14 (0.5–2.5 g/kg), and effects on growth hormone secretion were also identified 14 , 15 .…”

“…The arginine stimulation test is routinely used in clinical adult practice to assess insulin secretion by the pancreas. In the 1970s, a series of studies demonstrated the same effects in newborn and slightly preterm infants 14 – 17 . However, the current population of very preterm infants with hyperglycemia was not viable at this time, and the potential role of arginine in blood glucose control remains unexplored.…”

Levels of Glucose in Blood and Insulin in Plasma and Glucagon Response to Arginine Infusion in Low Birth Weight Infants

“…An increase of the levels of this hormone has been observed soon after birth (5,25). As reported elsewhere (12), values have been found to ' increase after arginine, demonstrating that arginine is a stimulus t o glucagon secretion in the human neonate. This is in agreement with reports of arginine administration in the rat fetus and neonate (1 1, 15).…”

“…In the adult such molar ratio has been found to change in correlation with the several metabolic needs. During the arginine test in the normal adult (2), as well as in the older child (12), an increase of the insulin to glucagon molar ratio has been described associated with an evident increase of the levels of glucose in blood. The values observed in the fasting low birth weight infants would favor glucose production by the liver; moreover, they did not change after the arginine infusion, which indicates an equimolar increase of the two hormones without any significant difference between the hypoglycemic SGAI and the other infants.…”