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The effects of early parenteral amino acids on sick premature infants
Ruth Heimler1, Janine M Bamberger, Ponthenkandath Sasidharan
1Department of Pediatrics, Medical College of Wisconsin and the Children's Hospital of Wisconsin, Milwaukee, WI 53217, USA.
Insights
Early amino acid supplementation in premature infants did not affect body weight or fluid shifts. However, it led to higher serum urea levels and improved nitrogen balance, suggesting benefits for nutritional support.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Metabolic Research
Background:
- Sick premature infants often require nutritional support to optimize growth and development.
- Parenteral amino acid administration is a key component of nutritional management in neonates.
- The optimal timing for initiating parenteral amino acids in sick premature infants remains an area of investigation.
Purpose of the Study:
- To investigate the impact of early versus delayed parenteral amino acid administration on body weight, fluid balance, and metabolic parameters in sick premature infants during the first week of life.
Main Methods:
- Randomized controlled trial comparing early (within 24 hours) versus delayed (day 4) parenteral amino acid administration in sick premature infants.
- Measurements included body weight, total body water, extracellular water, intracellular volume change, plasma amino acid and ammonia levels, urea levels, and nitrogen balance.
- Energy intake was standardized between groups.
Main Results:
- No significant differences in body weight or intracellular volume change were observed between groups, despite differing protein intake.
- Infants receiving early amino acids had significantly higher plasma urea levels compared to the delayed group.
- Early amino acid administration resulted in positive nitrogen balance, while the delayed group showed negative nitrogen balance.
Conclusions:
- Early parenteral amino acid administration does not significantly impact body weight or fluid distribution in sick premature infants.
- Higher serum urea concentrations are associated with early amino acid administration.
- Delayed amino acid provision led to negative nitrogen balance, highlighting the importance of timely nutritional support.
Objectives:
To study the effects of early parenteral amino acid administration on body weight, fluid compartments and metabolic parameters during the first week of life in sick premature infants.
Methods:
Appropriate for gestational age, sick premature infants were randomized into two groups. Group A infants (n=8, birth weight 1258±339 g) were supplemented with amino acids starting within 24 h of birth and advanced to 2.5 g/kg per day by day 3. Group G infants (n=9, birth weight 1182±214 g) received amino acids starting on day 4 of life. Energy intake was comparable in the 2 groups. Amino acid concentrations and nitrogen balance studies were performed on day 3 of life. Total body water and extracellular water were measured on day 1 and 8 and change in intracellular volume was calculated.
Results:
There was no significant difference between the 2 groups in terms of weight, intracellular volume change from day 1 to day 8 of life, despite a significant (P<0.01) difference in protein intake. Plasma ammonia levels were comparable in the 2 groups, but plasma urea levels were significantly higher in group A vs. group G infants (7.2±3.4 mmol/L vs. 3.2±1.2 mmol/L respectively, P<0.01). Nitrogen balance was positive in all group A infants and negative in group G infants. Nitrogen loss was inversely correlated with energy intake in group G infants (P<0.05). The mean plasma amino acid concentrations in group A infants (compared to those of group G) were within previously reported ranges in older premature infants.
Conclusions:
There was no significant effect on body weight and redistribution of body fluid compartments in infants receiving amino acids early during the first week of life. Serum urea concentrations were significantly higher in infants receiving early amino acids. Nitrogen losses in infants who did not receive amino acids were inversely correlated with energy intake during the first 3 days of life.
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