Relationship between arginine intake in parenteral nutrition and preterm neonatal population plasma arginine concentrations: a systematic review.
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.
['Premakumar|Chandini M|CM|', 'Turner|Mark A|MA|', 'Morgan|Colin|C|']
D001120:Arginine D004305:Dose-Response Relationship, Drug D006801:Humans D007231:Infant, Newborn D007234:Infant, Premature D010288:Parenteral Nutrition
arginine parenteral nutrition very preterm neonates