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Renal acid excretion in early infancy
Insights
Infants are prone to metabolic acidosis due to immature kidney function and formula feeding. Alkali therapy and modified formulas can prevent or treat this condition, which may be an evolutionary adaptation.
Area of Science:
- Neonatal physiology
- Pediatric nephrology
- Biochemistry
Background:
- Infants, especially preterm and small-for-gestational-age, exhibit a predisposition to metabolic acidosis.
- This is linked to immature renal acid excretion capacity and high acid load from standard infant formulas.
- Persistent maximum renal net acid excretion (NAE) has been observed in some infants, even with normal blood acid-base status.
Purpose of the Study:
- To investigate the complexities of acid-base metabolism disorders in early infancy.
- To explore the implications of persistent maximum renal NAE in vulnerable infant populations.
- To evaluate the efficacy of alkali therapy and formula modification for managing metabolic acidosis.
Main Methods:
- Analysis of acid-base metabolism in early infancy.
- Monitoring renal net acid excretion (NAE) in preterm and small-for-gestational-age infants.
- Assessment of alkali therapy and modified formula interventions.
Main Results:
- Incipient late metabolic acidosis is identified as a mixed disorder with maximum renal NAE.
- Alkali therapy proves highly effective, diagnosable via urine pH screening.
- Modified formulas reducing renal NAE, similar to human milk, offer a preventive strategy.
Conclusions:
- Infant metabolic acidosis is influenced by renal immaturity and nutrition.
- Alkali therapy and formula adjustments are effective management strategies.
- Low renal acid excretion capacity may be an evolutionary adaptation for energy conservation during breastfeeding.
Abstract:
In early infancy, complex disorders of acid base metabolism are more frequent than in any other age group, with a predisposition to metabolic acidosis due to an age-related low renal capacity for acid excretion and an unphysiologically high actual renal acid load in nutrition with common formulas. Recently in preterm and small-for-gestational-age infants, persistent maximum renal net acid excretion (NAE) with subnormal or normal blood acid base status, impaired weight gain, and adaptive hormonal reactions have been observed. Incipient late metabolic acidosis is one example of a mixed disorder of acid base metabolism with maximum renal NAE in early infancy. Alkali therapy is highly effective and can be realized both on an individual basis, using urine pH screening as a diagnostic criterium for maximum renal acid stimulation, or on a general preventive level using modified standard formula with a reduced actual renal NAE similar to that seen on alimentation with human milk. From an integrated point of view, the low glomerular filtration rate and renal capacity for acid excretion beyond the developmental age of more than 44 weeks, may well be interpreted as the result of a specific adaptation to breast feeding sparing energy, and thus an evolutionary advantage for the survival of mother and child.