ArticleJPEN. Journal of parenteral and enteral nutrition2026
Enteral and intravenous supplementation of arginine and citrulline fail to prevent necrotizing enterocolitis in preterm neonatal pigs.
Article in JPEN. Journal of parenteral and enteral nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- L-Citrulline in Maternal-Fetal and Neonatal Health: Metabolic Mechanisms and Emerging Therapeutic Applications.Nutrients · 2026Review
- Enteral and intravenous supplementation of arginine and citrulline fail to prevent necrotizing enterocolitis in preterm neonatal pigs.JPEN. Journal of parenteral and enteral nutrition · 2026Article
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Authors and funding
10 authors.
Funding
Abstract
backgroundNecrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in preterm infants with a morality rate that approaches 50%. Arginine has been widely studied in the field of clinical nutrition as a supplement for patients experiencing critical illness because it can be metabolized into nitric oxide, an important agent for supporting immunity and microcirculation. Citrulline has received less attention but can be metabolized into arginine and has a much longer plasma half-life than arginine. We used the highly translational preterm pig model to determine the effect of intravenous and enteral supplementation of arginine and citrulline on NEC incidence in preterm neonates.
methodsA total of 67 pigs were delivered by cesarean on day 105 of 115 (analogous to 30 weeks gestation in humans) and allocated to six treatments: preterm infant formula (control; CTL), donor human milk (DHM), formula with arginine (OG ARG) or citrulline (OG CIT), and formula with intravenous arginine (IV ARG) or citrulline (IV CIT). Pigs were monitored for clinical signs associated with NEC, and tissue was collected for later analysis. NEC diagnosis and severity was quantified using previously validated gross and histologic scales.
resultsEnteral and intravenous supplementation of arginine and citrulline did not impact NEC incidence or severity. NEC incidence tended (P < 0.07) to be lower in the DHM pigs. NEC incidence was highest in the CTL (60%), IV ARG (64%), and OG CIT (62.5%) pigs.
conclusionCitrulline and arginine supplementation are not feasible or safe nutrition strategies to prevent NEC in preterm neonates.
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