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Carnitine deficiency in preterm infants: A national survey of knowledge and practices
M A Clark1, R E K Stein2, Ellen J Silver2
1UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
Insights
Neonatal practitioners often lack awareness of carnitine deficiency risks in preterm infants receiving total parenteral nutrition (TPN). Few screen for deficiency or supplement, leaving infants vulnerable.
Area of Science:
- Neonatal Medicine
- Nutritional Science
- Biochemistry
Background:
- Carnitine is crucial for lipid metabolism, essential for developmental outcomes in preterm infants.
- Preterm infants receiving total parenteral nutrition (TPN) face a high risk of carnitine deficiency.
- Current standards for carnitine supplementation in this population are lacking.
Purpose of the Study:
- To evaluate the knowledge, beliefs, and practices of neonatal practitioners concerning carnitine deficiency in preterm infants.
- To assess current supplementation practices for preterm infants on TPN.
Main Methods:
- A cross-sectional electronic survey was distributed.
- The survey targeted neonatal practitioners via a nationally representative listserv.
- 492 practitioners completed the survey.
Main Results:
- Only 21% of respondents knew carnitine is placental-secreted; 72% believed deficiency was common.
- While 60% acknowledged serious consequences, only 5% routinely screened for deficiency.
- 40% routinely supplemented carnitine; more experienced practitioners (>5 years) were more likely to supplement.
Conclusions:
- Despite awareness of potential severity, screening and routine supplementation for carnitine deficiency remain low.
- Many preterm infants on TPN are at risk due to inadequate carnitine management.
- Further research is necessary to define risks and optimal supplementation strategies.
Objective:
Lipid supplementation improves developmental outcomes in preterm infants. Carnitine is essential for lipid metabolism; however, despite high risk for carnitine deficiency, there are no standards for carnitine supplementation in preterm infants receiving total parenteral nutrition (TPN). Our objective was to assess knowledge, beliefs and practices regarding preterm carnitine deficiency and supplementation among neonatal practitioners.
Methods:
Cross-sectional electronic survey administered via a nationally representative listserv of neonatal practitioners.
Results:
492 respondents participated in the survey. Only 21% of respondents were aware that carnitine is secreted by the placenta. 72% believed that carnitine deficiency was common, and 60% believed deficiency could have serious consequences. Five percent routinely screened for deficiency, and 40% routinely provided carnitine supplementation. Respondents with >5 years' experience were more likely to report using carnitine supplementation (50% vs. 38%).
Conclusions:
Although most respondents believed that carnitine deficiency is common and could have serious consequences, few screened for deficiency and fewer than half routinely supplemented. Thus, many preterm infants remain at risk for carnitine deficiency. Further research is needed to elucidate the risks of carnitine deficiency in these vulnerable infants.
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