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Increased parenteral amino acid administration to extremely low-birth-weight infants during early postnatal life
Peter J Porcelli1, Paula M Sisk
1Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. porcelli@wfubmc.edu
Insights
Extremely low birth weight infants tolerated increased parenteral amino acid intake up to 4 g/kg/day. This approach showed potential for improved weight gain without significant metabolic acidosis in very premature infants.
Area of Science:
- Neonatal Nutrition
- Pediatric Intensive Care
- Biochemistry
Background:
- Early parenteral amino acid administration is encouraged for growth in extremely low birth weight (ELBW) infants (birth weight <= 1,000 g).
- However, excessive intravenous amino acid intake may lead to metabolic acidosis and uremia in ELBW infants.
- This study investigated the tolerance and benefits of slightly increased early postnatal parenteral amino acid administration in ELBW infants.
Purpose of the Study:
- To determine if ELBW infants can tolerate and benefit from a slightly increased early postnatal parenteral amino acid administration.
- To assess the impact of increased amino acid intake on acid-base status and nitrogen balance in ELBW infants.
Main Methods:
- A study comparing a standard group (3 g/kg/day) with a modified group (4 g/kg/day) of parenteral amino acid dosage.
- Corrected dosage accounted for enteral protein intake, maintaining combined intake at or below 3 g/kg/day (standard) and 4 g/kg/day (modified).
- Primary outcome was plasma bicarbonate concentration; secondary outcomes included serum urea nitrogen and weight gain.
Main Results:
- The modified group received 16-18% greater corrected parenteral amino acid intake.
- No significant differences in serum bicarbonate levels were observed between groups.
- Increased parenteral amino acid intake was associated with mild increases in serum urea nitrogen and similar weight gain in both groups.
Conclusions:
- ELBW infants tolerated parenteral amino acid intake of approximately 4 g/kg/day.
- Mild increases in serum urea nitrogen and weight gain were observed with higher amino acid administration.
- Increased parenteral amino acid administration did not result in significant acidosis in ELBW infants.
Background:
Early administration of parenteral amino acids to infants with extremely low birth weight (birth weight < or = 1,000 g) has been encouraged to foster growth. However, excessive intravenous intake of amino acids may cause metabolic acidosis and uremia in extremely low birth weight infants. The hypothesis for this study was that extremely low birth weight infants would tolerate slightly increased early postnatal parenteral amino acid administration and benefit.
Methods:
The peak daily parenteral amino acid dosage was increased from 3 g/kg (standard group) to 4 g/kg (modified group). The corrected parenteral amino acid dosage was computed to account for enteral protein intake and keep the combined daily intravenous amino acid and enteral protein intake at or below 3 g . kg -1 . d -1 in the standard group and 4 g . kg -1 . d -1 in the modified group. The primary outcome measure was plasma bicarbonate concentration as an indicator of acid-base status. Data were collected for patient demographics, nutritional intake, serum bicarbonate and serum urea nitrogen concentrations, and outcome.
Results:
The corrected parenteral amino acid intake of the modified group was 16% greater at postnatal week 1 (3.30 +/- 0.83 g . kg -1 . d -1; mean, +/-1 SD) and 18% greater (3.86 +/- 0.94 g . kg -1 . d -1 ) at postnatal week 2 than the parenteral amino acid intake of the standard group. In the modified group, the mean serum bicarbonate concentration was 19.1 +/- 1.8 mEq/dL at week 1 and 23.9 +/- 2.9 mEq/dL at week 2, with no difference between the groups. At week 1, serum urea nitrogen concentrations were the same in both groups. The mean serum urea nitrogen concentration of the modified group at postnatal week 2 (18.2 +/- 8.8 mg/dL) was unchanged from postnatal week 1, but was greater than that of the standard group at postnatal week 2. Weight gain was the same in both groups. Corrected parenteral amino acid intake at postnatal week 1 correlated directly with weight gain from birth to postnatal week 2 ( P < 0.03) in both groups.
Conclusions:
Infants with extremely low birth weight tolerated parenteral amino acid intake of approximately 4 g . kg -1 . d -1. Mild increases of mean serum urea nitrogen concentration and mean weight gain were associated with increased parenteral amino acid administration without significant acidosis.
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