title: Asymmetric dimethylarginine and L-arginine levels in neonatal sepsis and septic shock.
abstract: OBJECTIVE
  Nitric oxide (NO) formed by the enzyme NO synthase (NOS) from L-arginine, is an important mediator for pathogen elimination. Being a potent vasodilator NO is implicated in hypotension and decreased organ perfusion in sepsis. Asymmetric dimethylarginine (ADMA) is an endogenous NOS inhibitor. We investigated ADMA and L-arginine levels in neonatal sepsis and their relation to disease severity.
  
  
  METHODS
  A prospective controlled study was conducted including 31 neonates with sepsis and 20 controls. Serum ADMA and L-arginine levels were measured within 24 h of sepsis diagnosis. Clinical and laboratory data including clinical risk index for babies (CRIB) score, presence of septic shock, organ dysfunction and death were recorded.
  
  
  RESULTS
  L-arginine and ADMA levels were higher in neonates with sepsis compared to controls (p = 0.029 and p = 0.001, respectively). Neonates with septic shock had higher ADMA levels compared to septic neonates without shock (p = 0.026) and controls (p < 0.001). L-arginine levels were higher in neonates with septic shock compared to septic neonates without shock (p = 0.012) and controls (p < 0.001). Survivors and non-survivors had similar L-arginine and ADMA levels. ADMA levels were correlated with CRIB score (rho = 0.320, p = 0.025).
  
  
  CONCLUSIONS
  L-arginine and ADMA levels are elevated in neonatal sepsis and even higher levels are observed in septic shock.
authors.affiliation: Department of Neonatology, Neonatal Intensive Care Unit, Etlik Zübeyde Hanım Women's Health Teaching and Research Hospital , Ankara , Turkey.
authors.forename: Ozge
authors.initials: O
authors.lastname: Aydemir
authors.forename: Beyza
authors.initials: B
authors.lastname: Ozcan
authors.forename: Husniye
authors.initials: H
authors.lastname: Yucel
authors.forename: Ahmet Yagmur
authors.initials: AY
authors.lastname: Bas
authors.forename: Nihal
authors.initials: N
authors.lastname: Demirel
mesh_terms: D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009102:Multiple Organ Failure / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood / Q000175:diagnosis / Q000401:mortality
chemical_list: D015415:Biomarkers; C018524:N,N-dimethylarginine; D001120:Arginine
keywords: Asymmetric dimethylarginine; l-arginine; neonatal sepsis; newborn; septic shock