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Nutritional strategy of early amino acid administration in very low birth weight infants
1Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Insights
Very low birth weight (VLBW) infants often face underfeeding and growth restriction. Current high-dose amino acid (AA) strategies do not consistently improve long-term outcomes in VLBW infants.
Area of Science:
- Neonatal nutrition
- Pediatric intensive care
- Growth and development
Background:
- Very low birth weight (VLBW) infants experience higher rates of underfeeding and growth restriction.
- Early and aggressive nutritional strategies are employed to improve outcomes in VLBW infants.
- Optimal parenteral amino acid (AA) dosing in early VLBW infant nutrition remains debated.
Purpose of the Study:
- To evaluate the effectiveness of early and high-dose amino acid (AA) regimens in VLBW infants.
- To determine if aggressive nutritional strategies improve long-term growth and neurodevelopmental outcomes.
- To investigate potential risks associated with high-dose AA supplementation in VLBW infants.
Main Methods:
- Review of randomized controlled trials (RCTs) on early and high-dose AA supplementation in VLBW infants.
- Analysis of studies comparing different AA dosing strategies and their impact on growth and neurodevelopment.
- Examination of metabolic disturbances and plasma AA levels in VLBW infants receiving high-dose AA.
Main Results:
- Most RCTs indicate that early, high-dose AA regimens (3.5-4.9 g/kg/day) do not enhance long-term growth or neurodevelopment.
- High-dose AA supplementation may cause early metabolic issues and disproportionate plasma AA levels.
- Infants of very low gestational age appear particularly susceptible to adverse effects of high-dose AA.
Conclusions:
- Current evidence does not support early, high-dose parenteral AA administration for improved long-term outcomes in VLBW infants.
- Further research is necessary to establish optimal AA dosing strategies for VLBW infants.
- The potential for metabolic disturbances necessitates caution with high AA doses in extremely premature infants.
Abstract:
Relative to a fetus of the same gestational age, very low birth weight (VLBW) infants are more likely to be underfed and to undergo growth restriction during their early hospital stay. The current trend towards "early and aggressive" nutritional strategies in VLBW infants aims to overcome the early nutritional deficiency and thereby boost postnatal catch-up growth, simultaneously improving long-term neurodevelopmental outcomes. Although the minimum starting amino acid (AA) dose to prevent negative nitrogen balance is well established, the upper limit and the rate of increase of early AA doses are controversial. Most randomized controlled trials show that early and high-dose (target, 3.5 to 4.9 g/kg/day) AA regimens, with or without high nonprotein calories, do not improve long-term growth and neurodevelopment. High-dose AA supplementation may lead to early metabolic disturbances and excessive or disproportionate plasma AA levels, particularly in infants of very low gestational age. Further large studies are needed to clarify the optimal strategy for early administration of parenteral AA doses in VLBW infants.
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