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Published on: June 28, 2024

Early Amino Acid Intake in ELBW Infants: School-Aged Outcomes From a Randomized Controlled Trial

David A Nyakotey1, Gavin T L Brown2, Barbara E Cormack1,3

  • 1Liggins Institute, University of Auckland, Auckland, New Zealand.

Pediatrics
|June 4, 2026
PubMed

Insights

Providing extra parenteral amino acids to extremely low birthweight (ELBW) infants did not improve neurocognitive outcomes. This intervention may negatively impact muscle strength and psychosocial functioning in ELBW children.

Area of Science:

  • Neonatal Medicine
  • Pediatric Nutrition
  • Developmental Neuroscience

Background:

  • Extremely low birthweight (ELBW) infants face significant risks for neurodevelopmental and physical challenges.
  • Optimizing early nutrition, including parenteral amino acids, is crucial for improving outcomes in ELBW infants.
  • The long-term effects of supplemental parenteral amino acids on neurocognitive function and physical development require further investigation.

Purpose of the Study:

  • To determine if additional parenteral amino acids in ELBW infants enhance neurocognitive function, lean mass, and muscle strength.
  • To assess the safety of this intervention regarding blood pressure and general health at school age.
  • To evaluate the impact on survival free of neurocognitive impairment.

Main Methods:

  • A multicenter, double-blinded, randomized trial compared additional parenteral amino acids (1 g/d for 5 days) versus placebo in ELBW infants.
  • Follow-up occurred at 6 to 7 years corrected age, assessing neurocognitive function using the NIH Toolbox.
  • Primary outcome was survival without neurocognitive impairment; secondary outcomes included measures of strength, body composition, and psychosocial health.

Main Results:

  • No significant difference was observed in survival free of neurocognitive impairment between the amino acid and placebo groups (21% vs 23%).
  • Children receiving additional amino acids exhibited lower muscle strength (relative handgrip strength z-score: -0.73 vs -0.33).
  • A potential increased risk of low psychosocial functioning was noted in the amino acid group (26% vs 18%).

Conclusions:

  • Supplemental parenteral amino acids for 5 days in ELBW infants show minimal to no benefit for neurocognitive outcomes at school age.
  • The intervention may be associated with adverse effects on muscle strength and psychosocial functioning.
  • Current evidence suggests limited long-term advantages and potential risks, warranting cautious consideration of this nutritional strategy.
Abstract

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