Enteral L-citrulline supplementation in preterm infants is safe and effective in increasing plasma arginine and
Amna Qasim1,2, Mohammad Q Mehdi1,3, Snigdha Bhatia1,4
1Department of Neonatology, Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA.
Insights
Enteral L-citrulline supplementation is safe and effective for preterm infants. It significantly increases plasma citrulline and arginine levels, improving nutritional support for vulnerable newborns.
Area of Science:
- Neonatal nutrition
- Amino acid metabolism
- Clinical pharmacology
Background:
- Citrulline and arginine deficiencies are linked to poor outcomes in preterm infants.
- Limited data exists on the efficacy of enteral supplementation for these deficiencies in preterm neonates.
Purpose of the Study:
- To evaluate the safety and efficacy of enteral L-citrulline supplementation in preterm infants.
- To determine the optimal dosage for increasing plasma citrulline and arginine levels.
Main Methods:
- A randomized trial involving 42 preterm infants (gestational age ≤33 weeks).
- Infants received enteral L-citrulline at low (100 mg/kg/day), medium (200 mg/kg/day), or high (300 mg/kg/day) doses for 7 days.
- Plasma levels of citrulline and arginine were measured pre- and post-supplementation.
Main Results:
- 95% of infants completed the 7-day supplementation without adverse events.
- Significant increases in plasma citrulline levels were observed across all dosage groups.
- Plasma arginine levels significantly increased in the high-dose L-citrulline group.
Conclusions:
- Enteral L-citrulline supplementation is a safe and effective strategy for preterm infants.
- Supplementation effectively raises plasma citrulline and arginine levels, potentially improving nutritional status.
Objective:
Deficiencies of citrulline and arginine have been associated with adverse outcomes in preterm-infants and data regarding enteral supplementation in preterm infants is limited.
Study Design:
This randomized -trial [NCT03649932] included 42 preterm infants (gestational age ≤33 weeks) randomized to receive enteral L-citrulline in low (100 mg/kg/day), medium (200 mg/kg/day) and high-dose (300 mg/kg/day) groups for 7 days. Plasma citrulline and arginine levels were obtained pre-and-post supplementation and efficacy was determined by a significant increase in levels after supplementation. A p < 0.05 was considered significant. Safety monitoring included blood-pressure-monitoring as well as complications and death during hospitalization.
Results:
A total of 40/42 (95%) of the recruits completed the 7-day supplementation with no adverse events. Plasma-citrulline levels increased significantly in all three groups while plasma-arginine levels increased significantly in the high-dose group.
Conclusion:
Enteral L-citrulline supplementation in preterm infants is safe and effective in increasing plasma citrulline and arginine levels.
Clinical Trial Registration:
NCT03649932 https://clinicaltrials.gov/ct2/show/NCT03649932 .
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