Enteral l-Arginine and Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is the most common acquired gastrointestinal disease in premature infants. The molecular basis of this multifactorial disease is poorly understood, and NEC diagnosis and treatment strategies still remain difficult and challenging. In current research, preventive approaches are of the utmost priority. Providing human milk to premature infants has been shown to be an effective intervention that decreases the incidence of NEC. Interestingly, recent reports reveal that l-arginine supplementation may be a promising prevention modality of NEC by promoting nitric oxide (NO) synthesis. Deficient or inadequate NO levels due to l-arginine deficiency or immaturity of NO synthase (NOS) activity in premature infants may lead to vasoconstriction and ischemia–reperfusion injury and may predispose the neonates to develop NEC. The role of l-arginine supplementation in NEC has been highlighted in numerous studies on experimental animal models and human neonates. These researches reveal that the prophylactic administration of l-arginine in low doses is safe with no adverse effects for the premature neonates and also that l-arginine supplementation appears to be effective in reducing the overall incidence of NEC in preterm infants and especially the incidence of Bell’s stage III NEC. The recent evidence on the l-arginine role in NEC pathophysiology opens up a new area in the field of NEC prevention and further supports the essential role of amino acids in nutrition and disease prevention.