Arginine intake in preterm infants
Research type
Research Study
Full title
Preterm Arginine INTake and metabolomics including ammonia levels in very preterm infants receiving parenteral nutrition (PAINT NH4)
IRAS ID
162716
Contact name
Colin Morgan
Contact email
Sponsor organisation
Liverpool Women's Foundation Trust
Duration of Study in the UK
0 years, 11 months, 31 days
Research summary
Very premature babies require high nutritional intakes to achieve normal growth, this is rarely achieved. Making proteins (synthesis) from amino acid (AA) “building blocks” is essential during growth. Many AA play an important role in biochemical pathways as well as providing the building blocks for protein synthesis. Arginine is an example of such an AA, where deficiency impairing an essential biochemical pathway (the urea cycle) is indicated by increased ammonia levels in the blood. There are many other chemicals that are not routinely measured but may help our understanding of how the body uses arginine (metabolism). A novel way of measuring these chemicals is called “metabolomics”. This could provide further evidence for impaired essential metabolic pathways. Such impairment would suggest insufficient arginine for protein synthesis and growth. Low arginine levels are associated with other complications in premature babies such as disordered blood sugar control, increased infection and life threatening lung and bowel problems. Premature babies cannot properly digest milk and in the first 2 weeks of life are dependent on intravenous (parenteral) nutrition (PN) to meet there nutritional needs while the gut adapts. We have shown that current PN AA formulations result in low blood arginine levels.
We will investigate the effect of current PN formulations on blood arginine and ammonia levels in premature babies, and use metabolomics to explore arginine metabolism in more detail. We will undertake a multicentre observational study in 20 very premature infants receiving the same PN AA formulation. We will record nutritional intake and routine biochemical testing data (which includes AA levels) collected over the first 14 days of life. We will take extra blood for analysis at prespecified intervals for ammonia levels (using a point of care testing device) and metabolomics (specialist laboratory analysis). There are no interventions that change standard clinical care.REC name
Wales REC 6
REC reference
15/WA/0057
Date of REC Opinion
4 Feb 2015
REC opinion
Favourable Opinion