Impact of early parenteral amino acid on preterm infant: A multicenter study

Early nutrition is essential for the growth and neurodevelopment of preterm infants, especially those with very low birth weight (VLBW). This multicenter retrospective cohort study aimed to evaluate the effects of early parenteral amino acid (AA) administration on growth outcomes, feeding patterns, and short-term neonatal outcomes.

This study included VLBW infants (<32 weeks of gestation) treated in six tertiary neonatal intensive care units across Taiwan between 2019 and 2023. Participants were grouped based on the timing of parenteral AA initiation (≤24 h or > 24 h after birth) and initial dose (≤2.5 g/kg/day or > 2.5 g/kg/day). Clinical outcomes and nutritional practices were compared across the groups.

Among the 959 infants, who received AAs earlier, the time to achieve full feeding was significantly shorter (23.4 ± 13.3 days vs. 26.2 ± 11.4 days, p = 0.035) compared to those who received AAs later. Among the 973 infants, infants receiving higher doses of AAs reached full feeding earlier (21.6 ± 14 days vs. 25.5 ± 12 days, p < 0.001) and had higher nadir body weights (981.1 ± 247.5 g vs. 941.8 ± 264.4 g, p = 0.028). Short-term outcomes, such as patent ductus arteriosus (PDA) requiring treatment (13.3 % vs. 19 %, p = 0.019), pulmonary hemorrhage (2.9 % vs. 5.7 %, p = 0.036), and moderate to severe bronchopulmonary dysplasia (BPD) (45.6 % vs. 54.3 %, p = 0.01), were significantly lower in the high-dose group. Multivariate logistic regression analysis revealed that the initial AA dose was independently associated with decreased risks of BPD and PDA.

Early initiation and higher doses of parenteral AAs were associated with improved feeding efficiency and reduced morbidities, such as PDA and BPD, in VLBW infants. Further large-scale and long-term studies are required to confirm these findings and determine the optimal dosing strategies.