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Metabolic differences between AGA-and SGA-infants of very low birthweight. III. Influence of postnatal age
Insights
Metabolic differences in protein and bile acid metabolism between small for gestational age (SGA) and appropriate for gestational age (AGA) very low birthweight (VLBW) infants diminish over time. Protein intake for VLBW infants should be carefully managed based on individual metabolic status.
Area of Science:
- Neonatal nutrition
- Pediatric gastroenterology
- Metabolic research
Background:
- Very low birthweight (VLBW) infants, particularly those small for gestational age (SGA), present unique metabolic challenges.
- Understanding the metabolic differences between SGA and appropriate for gestational age (AGA) VLBW infants is crucial for optimizing nutritional strategies.
Purpose of the Study:
- To investigate the metabolic differences in protein and bile acid metabolism between SGA and AGA VLBW infants during the first 42 days of life.
- To assess how these metabolic differences evolve over time with standard nutritional management.
Main Methods:
- Studied 7 SGA and 7 AGA VLBW infants fed breast milk fortified with freeze-dried human milk.
- Measured serum total bile acids (BA), renal excretion of total nitrogen (TN), and alpha-amino-nitrogen (AAN) on days 8, 21, and 42.
- Analyzed protein intake, ranging from 2.68 to 3.75 g/kg/day.
Main Results:
- On day 8, SGA infants showed significantly higher serum BA and renal excretion of TN and AAN compared to AGA infants.
- By day 21, these differences narrowed, with only serum BA and renal AAN remaining significantly higher in SGA infants.
- By day 42, only serum BA levels were elevated in SGA infants, indicating a diminishing metabolic disparity.
Conclusions:
- Metabolic differences related to protein and bile acid metabolism between moderately SGA and AGA VLBW infants decrease during the initial weeks of life.
- Nutritional management of VLBW infants requires consideration of individual metabolic capacities, with cautious and individualized protein intake adjustments.
- Further research into tailored nutritional interventions for VLBW infants based on their metabolic status is warranted.
Abstract:
Seven very low birthweight (VLBW) infants, small for gestational age (SGA), with moderate intrauterine growth retardation and 7 VLBW-infants, appropriate for gestational age (AGA), fed breast milk fortified with 6 g freeze-dried human milk per 100 ml were studied on the 8th, 21st and 42nd days of life. The protein intake on the study days varied between 2.68 and 3.61 g/kg/day in the SGA-and 2.69 and 3.75 g/kg/day in the AGA-infants. Serum concentrations of total bile acids (BA) and the renal excretion of total nitrogen (TN) as well as alpha-amino-nitrogen (AAN) were measured in all infants on each study day. On the 8th day of life a mean protein intake of 3.2 g/kg/day resulted in higher serum concentrations of BA as well as in a higher renal excretion of TN and AAN in the SGA-infants when compared to the AGA-infants. On the 21st day of life these differences were smaller and only the serum concentration of BA and the renal excretion of AAN were still significantly higher in the SGA-infants. On the 42nd day of life only serum concentrations of total BA were elevated in the SGA-infants when compared to that in the AGA-infants. The observed metabolic differences between moderately SGA-and AGA-infants related to protein and bile acid metabolism diminished during the first weeks of life. The present data suggest that when nutritional management of VLBW-infants is planned, differences in metabolic capacities must be considered and protein intake should be increased with caution and in accordance to the individual metabolic situation of the infants during the first weeks of life.