부산대학교 도서관

BACKGROUND: Arginine deficiency is well recognised in very preterm infants (VPI) receiving parenteral nutrition (PN) and is associated with major morbidity. Current UK PN amino acid (AA) formulations are AA-P (arginine 8.4 g/100 gAA) and AA-V (arginine 6.2 g/100 gAA). Human milk contains 4 g/100 gAA arginine. We hypothesised that hyperalimentation in PN-dependent VPI would prevent arginine deficiency irrespective of AA formulation. AIM: To compare the plasma arginine levels in VPI (reference range; RR:54–78 micromol/l) randomised to receive control PN (CPN) or hyperalimentation PN (HPN) regimens in two randomised controlled trials (RCT). METHODS: Both studies were single centre RCT with HPN containing 30% more protein/energy than CPN. RCT1 (AA-P) and RCT2 (AA-V) recruited infants <29weeks gestation. Actual daily protein/arginine intake was calculated using the nutritional intake data from the second week of life. Plasma AA levels were measured (week 2) if receiving >35% nutrients from PN. RESULTS: Plasma AA levels were obtained at median (IQR) postnatal age 9 (8–10) days in both RCT1 and RCT2. Both studies achieved significantly higher actual daily protein and arginine intakes (Table 1) in HPN compared to CPN infants (p < 0.01). All median essential AA levels exceeded RR. While there was a trend towards higher median plasma arginine levels with HPN regimens (not significant), these remained below RR. Lower PN arginine content (AA-V) in RCT2 resulted in lower arginine intake to RCT1 despite higher protein intakes.(Table is included in full-text article.) CONCLUSION: These study data demonstrate hyperalimentation does not prevent low plasma arginine levels in VPI. The proportion of arginine in current UK neonatal PN AA formulations is too low.