ArticleNutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition2026
Supplementary parenteral arginine corrects hypoargininaemia and rebalances plasma amino acid profiles in very preterm infants receiving parenteral nutrition: A prospective study.
Article in Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundPlasma amino acid (AA) profiles in parenteral nutrition (PN)-dependent very preterm infants (VPIs) consistently show overprovision of essential AA (EAA) and arginine deficiency. This may have implications for growth and immune/inflammatory responses.
aimTo compare plasma AA profiles on day 3 and day 10 in VPIs receiving standard PN (6.3 g/100 g AA arginine) and arginine-supplemented PN (18 g/100 g AA) in VPIs at <30 weeks' gestation.
methodsVPIs were allocated (according to intervention PN availability) in a series of separate physiological studies to receive standard PN or arginine-supplemented PN. This approach led to a final PN AA formulation design containing 18 g/100 g AA. Clinical, nutrition intake, and biochemical data were collected. Point-of-care testing was used to measure ammonia levels. Plasma AA levels were measured on days 3, 10 and 30 using ion exchange chromatography.
resultsThe highest mean daily arginine intake was on day 7: 521 mg/kg/day (142 mg/kg/day) at a dose of 18 g arginine/100 g parenteral AA. The median day 10 plasma arginine level was 85 (52-146) vs 41 (28-54) µmol/L for 18 g/100 g AA arginine vs control, respectively (P < 0.0001) The equivalent data for total EAA were 896 (750-1142) vs 1220 (1031-1428) µmol/L (P < 0.05) and blood ammonia levels were 46 (24-65) vs 51 (40-62) µmol/L (P = 0.28).
conclusionIn VPIs, PN arginine supplementation of 18 g/100 g AA increases arginine concentrations and reduces provision of EAA as demonstrated in the plasma AA profile. Higher plasma arginine levels are not sustained once parenteral arginine is discontinued. Blood ammonia levels were not useful in identifying individual arginine deficiency.
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