Arginine supplementation for prevention of necrotising enterocolitis in preterm infants

Arginine supplements for preventing severe, damaging inflammation of the gastrointestinal (GI) tract (necrotising enterocolitis) in infants born before 37 weeks gestation (preterm). Necrotising enterocolitis (NEC) may be caused by an infant's immaturity, a lack of blood flow to the GI tract (ischemia), and surface (mucosa) breakdown resulting from infection or feeding with strong/concentrated (hyperosmolar) solutions. It can result in feeding intolerance, problems with intestinal motility or a very sick infant. To protect the GI tract the body makes a natural substance, nitric oxide, from the amino acid arginine. Plasma arginine concentrations are reported to be low in very low birth weight infants and preterm infants who develop NEC. Adding extra arginine to the feeding solution may, therefore, prevent NEC. The review authors searched the literature for controlled studies evaluating the efficacy and safety of arginine supplementation. Adding extra arginine to a preterm infant's feed, starting between two to five days of age and continued until 28 days of age, reduced the risk of developing NEC in one good quality study (in 152 infants born at less than 32 weeks gestation). Five infants had to be treated for one to benefit. This was the only study identified and it had a high incidence of NEC possibly because it included even the lowest grade of NEC. No significant side effects directly attributable to too much arginine were observed. Possible effects of supplementing arginine are a lowering of blood pressure and change in control of blood glucose.