BACKGROUND: Arginine is considered an essential amino acid during critical illness in children, and supplementation of arginine has been proposed to improve arginine availability to facilitate nitric oxide (NO) synthesis. Protein-energy-enriched enteral formulas (PE-formulas) can improve nutrient intake and promote anabolism in critically ill infants. However, the effect of increased protein and energy intake on arginine metabolism is not known. OBJECTIVE: We investigated the effect of a PE-formula compared with that of a standard infant formula (S-formula) on arginine kinetics in critically ill infants. DESIGN: A 2-h stable-isotope tracer protocol was conducted in 2 groups of critically ill infants with respiratory failure because of viral bronchiolitis, who received either a PE-formula (n = 8) or S-formula (n = 10) in a randomized, blinded, controlled setting. Data were reported as means +/- SDs. RESULTS: The intake of a PE-formula in critically ill infants (aged 0.23 +/- 0.14 y) resulted in an increased arginine appearance (PE-formula: 248 +/- 114 mumol kg-1 h-1; S-formula: 130 +/- 53 mumol kg-1 h-1; P = 0.012) and NO synthesis (PE-formula: 1.92 +/- 0.99 mumol kg-1 h-1; S-formula: 0.84 +/- 0.36 mumol kg-1 h-1; P = 0.003), whereas citrulline production and plasma arginine concentrations were unaffected. CONCLUSION: In critically ill infants with respiratory failure because of viral bronchiolitis, the intake of a PE-formula increases arginine availability by increasing arginine appearance, which leads to increased NO synthesis, independent of plasma arginine concentrations. This trial was registered at www.trialregister.nl as NTR515.
de Betue, C. T. I., Joosten, K. F., Deutz, N. E., Vreugdenhil, A. C., & van Waardenburg, D. A. (2013). Arginine appearance and nitric oxide synthesis in critically ill infants can be increased with a protein-energy-enriched enteral formula. American Journal of Clinical Nutrition, 98(4), 907-916. https://doi.org/10.3945/ajcn.112.042523