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Pediatric parenteral amino acid mixture in low birth weight infants
1Department of Pediatrics, Columbia University College of Physicians and Surgeons, NY 10032.
Insights
This study evaluated an amino acid mixture for parenteral nutrition in low birth weight (LBW) infants. The mixture effectively supported growth and nitrogen retention, suggesting LBW infants can utilize parenteral amino acids effectively.
Area of Science:
- Neonatology
- Nutritional Science
- Biochemistry
Background:
- Parenteral nutrition is crucial for low birth weight (LBW) infants unable to receive adequate enteral feeding.
- Maintaining optimal plasma amino acid concentrations is essential for growth and development in LBW infants.
- Previous understanding of LBW infants' ability to metabolize parenteral amino acids was limited.
Purpose of the Study:
- To evaluate the efficacy of a novel amino acid mixture for parenteral nutrition in LBW infants.
- To assess plasma amino acid profiles and nitrogen balance in LBW infants receiving the mixture.
- To determine if LBW infants can effectively utilize parenterally administered amino acids.
Main Methods:
- A study involving 28 LBW infants (birth weight 750-1750g) requiring parenteral nutrition.
- Infants received parenteral nutrients for 5-21 days via peripheral or central veins.
- Plasma amino acid concentrations, weight gain, and nitrogen balance were monitored.
Main Results:
- Infants receiving central vein parenteral nutrition showed weight gain and nitrogen retention rates comparable to intrauterine rates.
- Plasma amino acid concentrations, except phenylalanine, remained within target ranges for most infants.
- While plasma tyrosine and cyst(e)ine levels were within goals, utilization of specific precursors (N-acetyl-L-tyrosine, cysteine HCl) was less efficient than in term infants.
Conclusions:
- The evaluated amino acid mixture is effective for parenteral nutrition in LBW infants.
- LBW infants demonstrate a greater capacity to utilize parenterally delivered amino acids than previously assumed.
- Further research may be needed to optimize specific amino acid precursor delivery for LBW infants.
Abstract:
A mixture of amino acids designed to maintain normal plasma amino acid concentrations in infants and children requiring parenteral nutrition was evaluated in 28 low birth weight (LBW) infants (birth weight, 750 to 1750 g; postnatal age, 1 to 4 weeks) who required parenteral nutrients for optimal nutritional management. Sixteen babies received only parenteral nutrients for five to 21 days. Ten of these received a typical regimen by peripheral vein (1.91 +/- 0.16 g/kg/d of amino acids and 44.7 +/- 4.4 kcal/kg/d) and six received a typical regimen through a central vein (2.39 +/- 0.11 g/kg/d of amino acids and 95.9 +/- 14.5 kcal/kg/d). Mean weight gain of the peripheral vein subgroup was 10.3 +/- 10.6 g/kg/d; mean nitrogen balance was 230 +/- 66 mg/kg/d. Both the mean rate of weight gain (17.2 +/- 5.1 g/kg/d) and the mean rate of nitrogen retention (267 +/- 49 g/kg/d) of the central vein subgroup were similar to intrauterine rates. In these two subgroups as well as the total population, plasma concentrations of all amino acids except phenylalanine were within the 95% confidence limits of the plasma concentrations observed in LBW infants fed sufficient amounts of human milk to result in a rate of weight gain similar to the intrauterine rate. However, although plasma tyrosine and cyst(e)ine concentrations were within the 95% confidence limits of the plasma concentrations goals, the LBW infant's ability to use N-acetyl-L-tyrosine and cysteine HCl appears to be even less than that of the term infant and older child. In toto, these data support the efficacy of the amino acid mixture evaluated for LBW infants. Of equal importance, they suggest that the LBW infant's ability to use parenterally delivered amino acids is not as limited as commonly thought.