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Serum choline in extremely preterm infants declines with increasing parenteral nutrition

Anders K Nilsson1, Anders Pedersen2, Daniel Malmodin2

  • 1Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. anders.k.nilsson@gu.se.

European Journal of Nutrition
|June 27, 2020
PubMed

Insights

Parenteral fluids negatively impact free choline levels in extremely preterm infants. Lower choline concentrations were observed with higher fluid intake, affecting infant development.

Area of Science:

  • Neonatal nutrition
  • Nutrient metabolism in preterm infants
  • Biochemical markers in neonates

Background:

  • Choline is vital for fetal and infant development.
  • Neonatal parenteral nutrition (PN) often lacks sufficient free choline.
  • PN may contain lipid-bound choline (phosphatidylcholine).

Purpose of the Study:

  • To investigate serum free choline, betaine, and methionine levels in extremely preterm infants.
  • To determine how parenteral fluid intake affects these nutrient concentrations.
  • To track longitudinal changes in these metabolites during the first 28 postnatal days and beyond.

Main Methods:

  • Prospective study of 87 infants with gestational age < 28 weeks.
  • Serum samples collected at multiple time points: PND 1, 7, 14, 28, and PMA 32, 36, 40 weeks.
  • Quantification of free choline, betaine, and methionine using 1H NMR spectroscopy.

Main Results:

  • Initial serum free choline at PND 1 was 33.7 µM, decreasing sharply by PND 7 to 18.4 µM.
  • Choline levels increased post-PND 7 but did not reach initial levels.
  • Higher parenteral fluid intake correlated negatively with serum free choline concentrations.

Conclusions:

  • Parenteral fluid administration significantly impacts circulating free choline levels in extremely preterm infants.
  • The proportion of parenteral fluids is a key factor influencing choline status.
  • Further research may be needed to optimize PN for choline delivery in this vulnerable population.
Abstract

Keywords:
BetaineEnteral nutritionHuman milkMethioninePhosphatidylcholineProton nuclear magnetic resonance

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