title: Enteral L-arginine supplementation for prevention of necrotizing enterocolitis in very low birth weight neonates: a double-blind randomized pilot study of efficacy and safety.
abstract: BACKGROUND
  Necrotizing enterocolitis (NEC) is the most common acquired gastrointestinal disease in premature infants and has high mortality and morbidity. Endothelial nitric oxide is an important regulator of vascular perfusion and is synthetized from the amino acid L-arginine. Hypoargininemia is frequently observed in preterm neonates and may predispose them to NEC. Our objective was to determine the effect of enteral L-arginine supplementation on the incidence and severity of NEC in very low birth weight (VLBW) neonates.
  
  
  METHODS
  We conducted a parallel blind randomized pilot study, comprising VLBW neonates with birth weight ≤1500 g and gestational age ≤34 weeks. VLBW neonates were randomly assigned to receive enteral L-arginine supplementation (1.5 mmol/kg/d bid) between the 3rd and 28th day of life or placebo. Diagnosis and classification of NEC were done according to modified Bell's criteria.
  
  
  RESULTS
  Eighty-three neonates were randomized to the arginine (n = 40) or placebo (n = 43) group. No adverse effects were observed in neonates receiving L-arginine supplementation. The incidence of NEC stage III was significantly lower in the arginine-supplemented group (2.5% vs 18.6%, P = .030).
  
  
  CONCLUSIONS
  Enteral L-arginine supplementation of 1.5 mmol/kg/d bid can be safely administered in VLBW neonates from the 3rd to the 28th day of life. Enteral L-arginine supplementation appears to reduce the incidence of stage III NEC in VLBW infants. Larger studies are needed to further evaluate the effect of L-arginine supplementation in preventing NEC in VLBW infants.
authors: Neonatal Intensive Unit, General District Hospital Athens "Alexandra," Athens, Greece.
authors: Elena
authors: E
authors: Polycarpou
authors: Sophia
authors: S
authors: Zachaki
authors: Maria
authors: M
authors: Tsolia
authors: Vasiliki
authors: V
authors: Papaevangelou
authors: Nicodemos
authors: N
authors: Polycarpou
authors: Despina D
authors: DD
authors: Briana
authors: Stavroula
authors: S
authors: Gavrili
authors: Christos
authors: C
authors: Kostalos
authors: Dimitrios
authors: D
authors: Kafetzis
mesh_terms: D001120:Arginine / Q000008:administration & dosage*; D019587:Dietary Supplements; D004311:Double-Blind Method; D004750:Enteral Nutrition; D020345:Enterocolitis, Necrotizing / Q000517:prevention & control*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development; D019102:Infant, Very Low Birth Weight; D008297:Male; D009569:Nitric Oxide / Q000378:metabolism; D010865:Pilot Projects
chemical_list: D009569:Nitric Oxide; D001120:Arginine
keywords: arginine supplementation; necrotizing enterocolitis (NEC); nitric oxide (NO)