Arginine Administration in Neonates

Route of Administration

Enteral administration is preferred when feeds are tolerated in neonates with conditions such as NEC, as recommended by ESPGHAN/ESPEN/ESPR/CSPEN guidelines 1
Consider enteral arginine supplementation when reintroducing feeds after NEC to help prevent recurrence 2

ESPGHAN/ESPEN/ESPR/CSPEN guidelines conditionally recommend arginine supplementation for prevention of NEC in preterm infants (Level of Evidence: 1-, Recommendation Grade B) 1
Arginine is the substrate for nitric oxide production, which is important for glucose homeostasis and vascular perfusion in neonates 1
Low plasma arginine levels are observed in preterm neonates and may predispose them to NEC 1
Arginine deficiency is related to immune suppression in newborn models of bacterial challenge 1

Ensure adequate non-protein caloric intake (minimum 30-40 kcal per 1g amino acids) to guarantee amino acid utilization in neonates receiving arginine supplementation 1, 2
During active NEC, bowel rest is recommended with discontinuation of enteral feeds as part of comprehensive management 1, 2
When reintroducing feeds after NEC, consider arginine supplementation to help prevent recurrence 2

Arginine supplementation could potentially lead to unwanted vasodilation and hypotension in septic patients 3
Studies in septic patients have shown variable effects on mortality with some suggesting possible harm 3
Current evidence does not strongly support intravenous or enteral supplementation of arginine as a single substance in critically ill patients 4, 5, 6