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Published on: November 20, 2015

Parenteral amino acid and metabolic acidosis in premature infants

Pushkaraj Jadhav1, Prabhu S Parimi, Satish C Kalhan

  • 1Schwartz Center for Metabolism and Nutrition and Department of Pediatrics, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA.

JPEN. Journal of Parenteral and Enteral Nutrition
|June 28, 2007
PubMed

Insights

Low-birth-weight infants receiving parenteral amino acids can develop metabolic acidosis within days. This condition occurs regardless of amino acid dosage or duration, highlighting the need for careful fluid management and monitoring of comorbidities.

Area of Science:

  • Neonatalogy
  • Pediatric Gastroenterology
  • Critical Care Medicine

Background:

  • Parenteral nutrition (PN) with amino acids is crucial for low-birth-weight infants to prevent nutritional deficits.
  • The impact of aggressive amino acid administration on infant acid-base balance remains understudied.

Purpose of the Study:

  • To investigate the effect of parenteral amino acid dose and duration on acid-base parameters in low-birth-weight infants.
  • To identify factors contributing to metabolic acidosis in this vulnerable population.

Main Methods:

  • A study involving 122 low-birth-weight infants (<32 weeks gestation, <1850 g) receiving varying doses and durations of parenteral amino acids.
  • Acid-base parameters were assessed at different time points (0-3 days and 3-5 days), with acidosis defined as pH <7.25.
  • Comparison with a control group receiving PN during the first 5 days of life.

Main Results:

  • Metabolic acidosis was observed in all infants between 2 and 5 days postpartum, irrespective of amino acid regimen.
  • Infants with patent ductus arteriosus (PDA) showed significantly lower pH, higher blood urea nitrogen, and greater weight loss.
  • Gestational age, weight loss, and PDA explained 65% of the variance in acidosis.

Conclusions:

  • Low-birth-weight infants commonly develop metabolic acidosis between 2-5 days of life, independent of parenteral amino acid administration details.
  • Optimizing parenteral fluid management and addressing comorbidities like PDA are essential for reducing acidosis incidence.
  • Effective management can promote protein accretion in these infants.
Abstract

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