Enteral L-Arginine and Glutamine Supplementation for Prevention of NEC in Preterm Neonates

Abstract

Objective. Evaluating the efficacy and safety of arginine and glutamine supplementation in decreasing the incidence of NEC among preterm neonates. Methods. Prospective case-control study done on 75 preterm neonates ≤34 weeks, divided equally into L-arginine group receiving enteral L-arginine, glutamine group receiving enteral glutamine, and control group. Serum L-arginine and glutamine levels were measured at time of enrollment (sample 1), after 14 days of enrollment (sample 2), and at time of diagnosis of NEC (sample 3). Results. The incidence of NEC was 9.3%. There was no difference in the frequency of NEC between L-arginine and control groups (P > 0.05). NEC was not detected in glutamine group; L-arginine concentrations were significantly lower in arginine group than control group in both samples while glutamine concentrations were comparable in glutamine and control groups in both samples. No significant difference was found between groups as regards number of septic episodes, duration to reach full oral intake, or duration of hospital stay. Conclusion. Enteral L-arginine supplementation did not seem to reduce the incidence of NEC. Enteral glutamine may have a preventive role against NEC if supplied early to preterm neonates. However, larger studies are needed to confirm these findings. This work is registered in ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT01263041).

A Review of the Immunomodulating Components of Maternal Breast Milk and Protection Against Necrotizing Enterocolitis

“…As TLR-2 and TLR-4 have established roles in inducing synthesis of inflammatory mediators and increasing apoptosis in NEC [52][53][54], their reduced expression by glutamine supplementation suggests a mechanism by which it mediates protection. In a small study that evaluated the outcomes of arginine and glutamine supplementation in 25 preterm neonates of less than 34 weeks' gestation, there were no infants that developed NEC in the glutamine group and no difference in the NEC incidence in the arginine group [55]. However, large RCTs of infants diagnosed with severe gastrointestinal disease, including NEC, spontaneous intestinal perforation, and intestinal structural anomalies, did not show a decreased risk of death or severe infections while receiving enteral glutamine [56].…”

Carbamyol phosphate synthetase 1 gene (4217C>A) polymorphism and its relation to low plasma arginine level among preterm with necrotizing enterocolitis; a single center Egyptian study

“…8,9,23 ; Richir et al, 24 reported that preterm infants with NEC showed significantly low L-arginine level than those without NEC. Further, Amin et al, 25 who investigate the role of enteral L-arginine supplementation in prevention of NEC, concluded that plasma L-arginine level was significantly low at time of diagnosis of NEC. Regarding CPS1 gene (4217C>A) polymorphism, we disclosed no significant difference in genotypes and allele distribution between preterm cases and preterm controls.…”

Antibiotics Effects on the Fecal Metabolome in Preterm Infants

“…Models of sepsis and gut inflammation have shown decreased uptake of glutamine by enterocytes [35]. Supplementation with glutamine has been studied in prevention of NEC in preterm infants, as it has been found to decrease the possibility of bacterial translocation across enterocytes [36]. The decreased concentration in the antibiotic group may be secondary to increased use in maintenance of the mucosal barrier and in further proliferation of enterocytes ( Figure 6).…”