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Plasma amino acids in small preterm infants fed on human milk or formula
1Department of Child Health, St George's Hospital Medical School, London.
Insights
Formula-fed preterm infants showed faster weight gain and potentially accelerated liver maturation compared to breast milk-fed infants. However, breast milk feeding was associated with lower essential amino acid levels and two toxic concentrations.
Area of Science:
- Neonatal Nutrition
- Biochemistry
- Pediatric Gastroenterology
Background:
- Preterm infants have unique nutritional needs due to immature physiological systems.
- Feeding choices, such as preterm formula versus expressed maternal breast milk, significantly impact neonatal development.
- Understanding plasma amino acid profiles is crucial for assessing nutritional status and metabolic outcomes in preterm infants.
Purpose of the Study:
- To compare plasma amino acid concentrations in preterm infants fed either preterm formula or expressed maternal breast milk.
- To investigate the relationship between feeding type, growth, and amino acid profiles.
- To assess potential impacts on liver maturation and risk of amino acid toxicity.
Main Methods:
- Plasma amino acid levels were measured in 35 preterm infants (11 <1000g, 24 1000-1500g).
- Repeat sampling was performed on 18 infants after at least seven days.
- Infants were fed either preterm formula (17) or expressed maternal breast milk (18) at 1-2 hour intervals.
Main Results:
- Formula-fed infants exhibited faster weight gain compared to breast milk-fed infants.
- Plasma amino acid patterns showed minimal differences between feeding groups.
- Breast milk-fed infants were more likely to have essential amino acid concentrations below the mid-trimester fetal range.
- Two samples in the breast milk group approached toxic amino acid concentrations.
- The ratio of branched-chain to aromatic amino acids was higher in formula-fed infants, suggesting accelerated liver maturation.
Conclusions:
- While formula feeding promoted faster weight gain and potentially enhanced liver maturation in preterm infants, breast milk feeding was associated with a higher risk of suboptimal essential amino acid levels.
- Careful monitoring for amino acid toxicity is warranted, particularly in breast milk-fed preterm infants.
- Further research is needed to fully elucidate the long-term metabolic implications of different feeding strategies in preterm neonates.
Abstract:
Plasma amino acids were measured in 35 preterm infants, of whom 11 weighed less than 1000 g and 24 weighed between 1000 g and 1500 g at the time of sampling. Repeat samples were obtained in 18 at least seven days later. Seventeen infants were fed with preterm formula milk and 18 with expressed maternal breast milk at one to two hourly intervals during the study period. Formula fed infants gained weight faster than those fed on breast milk but there was little difference in amino acid patterns. Infants fed on breast milk were more likely to have concentrations of essential amino acids below the mid trimester fetal range than formula fed infants, but few infants in either feeding group had values above the fetal range. Those that did were equally distributed between both groups. Only two samples approached toxic concentrations, both in the group fed breast milk. The ratio of branched chain to aromatic amino acids was higher in the group fed on formula after correction for post conceptional age, implying that liver maturation may be accelerated by formula feeding. No correlations were found between plasma amino acid concentrations and nitrogen retention or metabolisable energy intake.