title: Plasma arginine levels and blood glucose control in very preterm infants receiving 2 different parenteral nutrition regimens.
abstract: BACKGROUND
  Improving parenteral nutrition (PN) amino acid (AA) intake in very preterm infants is associated with less hyperglycemia. AAs stimulate newborn insulin secretion with arginine, demonstrating a specific effect. We hypothesized that low arginine levels would be associated with increased insulin-treated hyperglycemia and higher mean daily blood glucose levels in very preterm infants.
  
  
  METHODS
  We performed a secondary analysis on previous study data comparing high-protein/calorie PN (HPC-PN) and control groups in infants <29 weeks' gestation. Infants were substratified (within original groups) according to high (highARG) and low (lowARG) plasma arginine levels on days 8-10 using a reference population-derived threshold for high/low arginine (57 µmol/L). Daily protein, arginine, carbohydrate intake, mean daily blood glucose, and insulin treatment data from the first 15 days of life were collected.
  
  
  RESULTS
  Control group infants (n = 60) were stratified into lowARG (n = 41) and highARG (n = 19) groups. There were no differences in basic demographic data or carbohydrate intake. LowARG infants had higher mean daily blood glucose levels ( P .05) and a trend to more insulin treatment on days 610. HPC-PN group infants (n = 55) were stratified into lowARG (n = 33) and highARG (n = 22) GROUPS. LowARG infants had lower gestation and birth weight and were sicker than highARG infants. There were no differences in carbohydrate intake. LowARG infants had higher mean daily blood glucose levels (p .01) and more insulin treatment (p .01) on days 15 and 610. Insulin-treated hyperglycemia was also associated with low plasma glutamine levels.
  
  
  CONCLUSIONS
  Low plasma arginine levels (≤57 µmol/L) in very preterm infants are associated with poorer blood glucose control.
authors.affiliation: Department Neonatology, Liverpool Women's Hospital, Liverpool, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Burgess
authors.forename: Colin
authors.initials: C
authors.lastname: Morgan
authors.forename: Kelly
authors.initials: K
authors.lastname: Mayes
authors.forename: Maw
authors.initials: M
authors.lastname: Tan
mesh_terms: D001120:Arginine / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood*; D001724:Birth Weight; D001786:Blood Glucose / Q000378:metabolism*; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000209:etiology; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood*; D007328:Insulin / Q000378:metabolism; D000078790:Insulin Secretion; D008297:Male; D010288:Parenteral Nutrition / Q000379:methods*
chemical_list: D001786:Blood Glucose; D004044:Dietary Proteins; D007328:Insulin; D001120:Arginine
keywords: amino acids; arginine; hyperglycemia; insulin; parenteral nutrition; preterm