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Relationship between arginine intake in parenteral nutrition and preterm neonatal population plasma arginine concentrations: a systematic review.

ABSTRACT: CONTEXT:Very preterm neonates (VPNs) are unable to digest breast milk and therefore rely on parenteral nutrition (PN) formulations. This systematic review was prepared following PRISMA-P 2015 guidelines. For the purpose of this review, desirable mean plasma arginine concentration is defined as ?80 micromoles/L. OBJECTIVE:The review was performed to answer the following research question: "In VPNs, are high amounts of arginine in PN, compared with low amounts of arginine, associated with appropriate circulating concentrations of arginine?" Therefore, the aims were to 1) quantify the relationship between parenteral arginine intakes and plasma arginine concentrations in PN-dependent VPNs; 2) identify any features of study design that affect this relationship; and 3) estimate the target parenteral arginine dose to achieve desirable preterm plasma arginine concentrations. DATA SOURCES:The PubMed, Scopus, Web of Science, and Cochrane databases were searched regardless of study design; review articles were not included. DATA EXTRACTION:Only articles that discussed amino acid (AA) intake and measured plasma AA profile post PN in VPNs were included. Data were obtained using a data extraction checklist that was devised for the purpose of this review. DATA ANALYSIS:Twelve articles met the inclusion criteria. The dose-concentration relationship of arginine content (%) and absolute arginine intake (mg/(kg × d)) with plasma arginine concentrations showed a significant positive correlation (P < 0.001). CONCLUSION:Future studies using AA solutions with arginine content of 17%-20% and protein intakes of 3.5-4.0?g/kg per day may be needed to achieve higher plasma arginine concentrations.

SUBMITTER: Premakumar CM

PROVIDER: S-EPMC6888765 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Relationship between arginine intake in parenteral nutrition and preterm neonatal population plasma arginine concentrations: a systematic review.

Premakumar Chandini M CM Turner Mark A MA Morgan Colin C

Nutrition reviews 20191201 12

<h4>Context</h4>Very preterm neonates (VPNs) are unable to digest breast milk and therefore rely on parenteral nutrition (PN) formulations. This systematic review was prepared following PRISMA-P 2015 guidelines. For the purpose of this review, desirable mean plasma arginine concentration is defined as ≥80 micromoles/L.<h4>Objective</h4>The review was performed to answer the following research question: "In VPNs, are high amounts of arginine in PN, compared with low amounts of arginine, associate ...[more]

PMID: 31504841

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Project description:BackgroundInfants born <29 weeks gestation are at high risk of neurocognitive disability. Early postnatal growth failure, particularly head growth, is an important and potentially reversible risk factor for impaired neurodevelopmental outcome. Inadequate nutrition is a major factor in this postnatal growth failure, optimal protein and calorie (macronutrient) intakes are rarely achieved, especially in the first week. Infants <29 weeks are dependent on parenteral nutrition for the bulk of their nutrient needs for the first 2-3 weeks of life to allow gut adaptation to milk digestion. The prescription, formulation and administration of neonatal parenteral nutrition is critical to achieving optimal protein and calorie intake but has received little scientific evaluation. Current neonatal parenteral nutrition regimens often rely on individualised prescription to manage the labile, unpredictable biochemical and metabolic control characteristic of the early neonatal period. Individualised prescription frequently fails to translate into optimal macronutrient delivery. We have previously shown that a standardised, concentrated neonatal parenteral nutrition regimen can optimise macronutrient intake.MethodsWe propose a single centre, randomised controlled exploratory trial of two standardised, concentrated neonatal parenteral nutrition regimens comparing a standard macronutrient content (maximum protein 2.8 g/kg/day; lipid 2.8 g/kg/day, dextrose 10%) with a higher macronutrient content (maximum protein 3.8 g/kg/day; lipid 3.8 g/kg/day, dextrose 12%) over the first 28 days of life. 150 infants 24-28 completed weeks gestation and birthweight <1200 g will be recruited. The primary outcome will be head growth velocity in the first 28 days of life. Secondary outcomes will include a) auxological data between birth and 36 weeks corrected gestational age b) actual macronutrient intake in first 28 days c) biomarkers of biochemical and metabolic tolerance d) infection biomarkers and other intravascular line complications e) incidence of major complications of prematurity including mortality f) neurodevelopmental outcome at 2 years corrected gestational age.Trial registrationCurrent controlled trials: ISRCTN76597892; EudraCT Number: 2008-008899-14.

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Relationship between arginine intake in parenteral nutrition and preterm neonatal population plasma arginine concentrations: a systematic review.

Publications

Relationship between arginine intake in parenteral nutrition and preterm neonatal population plasma arginine concentrations: a systematic review.

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