667 - Association Between Prophylactic Arginine Supplementation in Premature Infants Born Before 29 Weeks Gestational Age and Long-Term Neurodevelopmental Outcomes at 36 Months Corrected Age

Publication Number: 2650.667

Anum Rahman, University of Calgary, Calgary, AB, Canada; Amelie Stritzke, University of Calgary, Calgary, AB, Canada; Stefani M. Doucette, University of Calgary, Calgary, AB, Canada; Amina Benlamri, university of calgary, calgary, AB, Canada; Harish Amin, University of Calgary, Calgary, AB, Canada; Sunil K. Jain, University of Texas Medical Branch, Galveston, TX, United States; Jaideep Kanungo, University of Ca=ary Cumming School of Medicine, Calgary, AB, Canada; Selphee Tang, Alberta Health Services, Calgary, AB, Canada; Sue Makarchuk, Alberta Health Services, Calgary, AB, Canada; Abhay Lodha, University of Calgary,Cumming School of Medicine, Calgary, AB, Canada

Background: In preterm infants, prophylactic supplementation with L-arginine, a precursor for nitric oxide, has been shown to reduce the incidence of necrotizing enterocolitis (NEC). The role of L-arginine in preventing neurodevelopmental impairment (NDI) in preterm infants remains unknown

Objective: To explore the association between prophylactic arginine supplementation in preterm infants born before 29 weeks of gestational age (GA) and the risk of death or NDI at 3 years of corrected age (CGA)

Design/Methods: This retrospective cohort study examined infants born before 29 weeks of gestation who were admitted to our regional NICU between August 1999 and May 2007 and subsequently followed up in our regional neonatal follow-up clinic. Two groups were compared: the pre-arginine supplementation cohort (Group I, August 1999-March 2003) and the post-arginine supplementation cohort (Group II, October 2003-May 2007), following the implementation of routine arginine supplementation in April 2003, with a 6-month washout period. The primary outcome was a composite of death and NDI. NDI was considered present if a child had any of the following: any type of cerebral palsy, cognitive score >1 SD below the mean, unilateral or bilateral sensorineural hearing loss with or without amplification or cochlear implants, or visual impairment with corrected visual acuity < 20/60 or bilateral blindness with corrected visual acuity < 20/200 in the better eye diagnosed up to 3-year CGA. Logistic regression analysis was used to adjust for potential confounding variables.

Results: A total of 676 eligible infants were followed up in our regional follow-up clinic at 3 years CGA-276 in the pre-arginine group and 318 in the post-arginine group (Figure 1). Eighty-two infants were lost to follow-up. Maternal and neonatal demographic characteristics are presented in Table 1. After adjusting for confounders, the odds ratio for death or NDI and for any NDI in the post-arginine group was 0.35 (95% CI: 0.23-0.53) and 0.36 (95%CI: 0.22-0.57) respectively (Table 2). Detailed secondary outcomes are also shown in Table 2.

Conclusion(s): In preterm infants born before 29 weeks of GA, prophylactic arginine supplementation was associated with a reduced risk of the composite outcome of death or NDI at 3 years CGA.

Figure 1: Flow Diagram of the Study Population


Table 1: Maternal and Neonatal Characteristics


Table 2: Neurodevelopmental Outcomes at 36 Months Corrected Gestational Age