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Urinary citrulline in very low birth weight preterm infants receiving intravenous nutrition

Aurélie Bourdon1, Carole Rougé, Arnaud Legrand

  • 1INRA, UMR 1280, Physiologie des Adaptations Nutritionnelles, Université de Nantes, 44093 Nantes Cedex 1, France.

The British Journal of Nutrition
|December 14, 2011
PubMed

Insights

Urinary citrulline levels in preterm infants do not indicate gastrointestinal tolerance to feeding. Citrulline biosynthesis, influenced by NO-synthase, appears to be a key factor, not GI function.

Area of Science:

  • Neonatology
  • Gastroenterology
  • Biochemistry

Background:

  • Very low birth weight (VLBW) preterm infants rely on parenteral nutrition (PN) due to immature gastrointestinal (GI) systems.
  • Weaning infants off PN is crucial due to associated complications, but lacks a reliable GI maturity index.
  • Plasma citrulline is an established GI function marker in adults, prompting investigation in neonates.

Purpose of the Study:

  • To identify factors influencing urinary citrulline excretion in preterm infants.
  • To assess if urinary citrulline can serve as a non-invasive marker for GI tolerance to enteral feeding.
  • To explore the relationship between nutritional intake and urinary citrulline levels.

Main Methods:

  • Bi-weekly monitoring of nutritional intake and urinary citrulline in 47 preterm infants (<1500g).
  • Analysis included multivariate regression to identify correlations between urinary citrulline and clinical factors.
  • Assessment of relationships with post-conceptional age, parenteral amino acid supply, enteral feeding volume, and urinary nitrite+nitrate excretion.

Main Results:

  • Median urinary citrulline was 24.7 μmol/mmol creatinine.
  • No significant correlation was found between urinary citrulline and the percentage of enteral energy tolerated.
  • Weak correlations existed with post-conceptional age, parenteral amino acid supply, and enteral feeding volume. A significant correlation was observed with urinary nitrite+nitrate excretion.

Conclusions:

  • Urinary citrulline excretion in preterm infants is primarily determined by citrulline biosynthesis from arginine via NO-synthase.
  • Urinary citrulline is not a reliable predictor of gastrointestinal tolerance to enteral feeding in this population.
  • Neonatal gut physiology differs from adults, with in situ conversion of citrulline to arginine, limiting its utility as a renal marker.

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