Abstract 630

Necrotizing enterocolitis is the most common severe intestinal disease of the newborn, with a prevalence of 10% in premature infants. Deficiencies in certain amino acids, such as glutamine (GLN) and arginine (ARG), may play a role in the subsequent development of NEC. We conducted a prospective cohort study of serum amino acids and urea levels in premature infants < 1800 gms. Patients were included if blood was drawn on at least 3 consecutive intervals (days of life): 1, 3, 7, 14, 21, and 28. Serum amino acid levels were measured by HPLC. Controls (n=32) and NEC patients (n=12, defined by symptoms and the presence of pneumatosis intestinalis) were comparable with respect to birthweight, gestational age, and APGAR scores. The mean age of onset of NEC was 16 days (95% C.I. 12-20). All amino acid concentrations were similar comparing control and NEC patients on days of life 1 & 3. On days 7 & 14, [GLN], [ARG], [ALA], [HIS], [ORN], and [THR] were decreased 30-60% (p≤0.05) in NEC patients compared with controls. Total non-essential and total amino acids were also lower in NEC patients (p≤0.05) on days 7 & 14. There was no change in serum [ILE], [PRO],[TRP], or [urea] on any of the study days.

This is the first study to document amino acid deficiencies other than ARG deficiency in infants who develop NEC. Because GLN and ARG have protective functions in the intestine, we suggest a reevaluation of the dosing of amino acids in parenteral nutrition to determine if normalization of amino acid levels prevents NEC. (Table)

Table 1 No caption available.
Full size table