title: Reduced plasma citrulline levels in low birth weight infants with necrotizing enterocolitis.
abstract: BACKGROUND
  Citrulline, a nonprotein amino acid, is an intermediate of the urea cycle and synthesized in small intestine. Lower plasma citrulline levels were associated with reduced function of enterocytes. Necrotizing enterocolitis (NEC) causes high morbidity and mortality, and leads impaired intestinal functions.
  
  
  METHODS
  Plasma citrulline levels of neonates with a gestational age <32 weeks and ≤1,500 gm who developed NEC stage II/III were measured by high-performance liquid chromatography.
  
  
  RESULTS
  We enrolled 36 preterm infants including 20 with NEC and 16 controls. Median citrulline levels of NEC and control groups were 8.6 and 20.18 μmol/l (P < 0.05), and cut off level of citrulline was 13.15 μmol/l with a sensitivity of 80% and a specificity of 82%. Median arginine levels of NEC and control groups were 22.02 and 39.89 μmol/l (P < 0.05), and cut off level of arginine was 28.52 μmol/l with a sensitivity of 70% and a specificity of 75%. Blood sampling day, gender, parenteral, and enteral nutrition did not affect the amino acid levels.
  
  
  CONCLUSIONS
  We found lower plasma citrulline and arginine levels in preterm infants with NEC. Further studies are needed to determine most appropriate levels to predict recovery and prognosis of NEC, and treatment options with these amino acids in preterm infants.
authors.affiliation: Division of Neonatology, Neonatal Intensive Care Unit, Mersin Maternal and Child Health Hospital, Mersin, Turkey. istemihancelik@gmail.com
authors.forename: Istemi Han
authors.initials: IH
authors.lastname: Celik
authors.forename: Gamze
authors.initials: G
authors.lastname: Demirel
authors.forename: Fuat Emre
authors.initials: FE
authors.lastname: Canpolat
authors.forename: Ugur
authors.initials: U
authors.lastname: Dilmen
mesh_terms: D001120:Arginine / Q000097:blood; D002956:Citrulline / Q000097:blood*; D020345:Enterocolitis, Necrotizing / Q000097:blood*; D005260:Female; D005973:Glutamine / Q000097:blood; D006801:Humans; D007230:Infant, Low Birth Weight / Q000097:blood*; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood*; D007235:Infant, Premature, Diseases / Q000097:blood*; D008297:Male; D011446:Prospective Studies
chemical_list: D005973:Glutamine; D002956:Citrulline; D001120:Arginine
keywords: necrotizing enterocolitis; plasma citrulline; premature infants