Plasma citrulline levels in preterm neonates with necrotizing enterocolitis

Area of Science:

• Neonatal Medicine
• Biochemistry
• Gastroenterology

Background:

• Citrulline, a non-protein amino acid, is synthesized in the small intestine.
• In children with short-bowel syndrome, citrulline indicates residual bowel length and parenteral nutrition (PN) independence.
• The study investigates citrulline's utility in preterm neonates with necrotizing enterocolitis (NEC).

Purpose of the Study:

• To assess the diagnostic and monitoring value of plasma citrulline levels in preterm neonates with NEC.
• To establish reference ranges for plasma citrulline in healthy preterm neonates.
• To correlate citrulline levels with NEC severity and treatment response.

Main Methods:

• Plasma citrulline levels were prospectively measured in 17 preterm neonates with NEC stage II.
• Serial citrulline levels were compared to those of 24 healthy preterm neonates at specific days of life (DOL).
• Statistical analysis was performed to determine significant differences and optimal cut-off values.

Main Results:

• Healthy preterm neonates showed increasing plasma citrulline levels with age.
• Preterm neonates with NEC had significantly lower plasma citrulline levels compared to controls.
• An optimal citrulline cut-off of 17.75 μmol/L distinguished NEC patients (sensitivity 76%, specificity 87%).
• Lower citrulline levels correlated with longer parenteral nutrition duration.
• Citulline levels increased with enteral nutrition reintroduction.

Conclusions:

• Reduced plasma citrulline levels are observed in preterm neonates with NEC.
• Serial citrulline measurements may aid in monitoring the improvement of enterocyte mass during NEC management.
• Citrulline shows potential as a biomarker for NEC progression and recovery.