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Robinson DT, Calkins KL, Chen Y, Cober MP, Falciglia GH, Church DD, Mey J, McKeever L, Sentongo T. Guidelines for parenteral nutrition in preterm infants: The American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr 2023; 47:830-858. [PMID: 37610837 DOI: 10.1002/jpen.2550] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 05/12/2023] [Accepted: 05/31/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Parenteral nutrition (PN) is prescribed for preterm infants until nutrition needs are met via the enteral route, but unanswered questions remain regarding PN best practices in this population. METHODS An interdisciplinary committee was assembled to answer 12 questions concerning the provision of PN to preterm infants. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) process was used. Questions addressed parenteral macronutrient doses, lipid injectable emulsion (ILE) composition, and clinically relevant outcomes, including PNALD, early childhood growth, and neurodevelopment. Preterm infants with congenital gastrointestinal disorders or infants already diagnosed with necrotizing enterocolitis or PN-associated liver disease (PNALD) at study entry were excluded. RESULTS The committee reviewed 2460 citations published between 2001 and 2023 and evaluated 57 clinical trials. For most questions, quality of evidence was very low. Most analyses yielded no significant differences between comparison groups. A multicomponent oil ILE was associated with a reduction in stage 3 or higher retinopathy of prematurity (ROP) compared to an ILE containing 100% soybean oil. For all other questions, expert opinion was provided. CONCLUSION Most clinical outcomes were not significantly different between comparison groups when evaluating timing of PN initiation, amino acid dose, and ILE composition. Future clinical trials should standardize outcome definitions to permit statistical conflation of data, thereby permitting more evidence based recommendations in future guidelines. This guideline has been approved by the ASPEN 2022-2023 Board of Directors.
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Affiliation(s)
- Daniel T Robinson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Kara L Calkins
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | - M Petrea Cober
- Akron Children's Hospital, Akron, Ohio, USA
- College of Pharmacy, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Gustave H Falciglia
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - David D Church
- Department of Geriatrics, Donald W. Reynolds Institute on Aging, Center for Translational Research in Aging & Longevity, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jacob Mey
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Liam McKeever
- Department of Clinical Nutrition Chicago, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy Sentongo
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
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Carnitine Intake and Serum Levels Associate Positively with Postnatal Growth and Brain Size at Term in Very Preterm Infants. Nutrients 2022; 14:nu14224725. [PMID: 36432412 PMCID: PMC9696952 DOI: 10.3390/nu14224725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 11/11/2022] Open
Abstract
Carnitine has an essential role in energy metabolism with possible neuroprotective effects. Very preterm (VPT, <32 gestation weeks) infants may be predisposed to carnitine deficiency during hospitalization. We studied the associations of carnitine intake and serum carnitine levels with growth and brain size at term equivalent age (TEA) in VPT infants. This prospective cohort study included 35 VTP infants admitted to Kuopio University Hospital, Finland. Daily nutrient intakes were registered at postnatal weeks (W) 1 and 5, and serum carnitine levels were determined at W1, W5, and TEA. The primary outcomes were weight, length, and head circumference Z-score change from birth to TEA, as well as brain size at TEA in magnetic resonance imaging. Carnitine intake at W1 and W5, obtained from enteral milk, correlated positively with serum carnitine levels. Both carnitine intake and serum levels at W1, W5, and TEA showed a positive correlation with weight, length, and head circumference Z-score change and with brain size at TEA. In linear models, independent positive associations of carnitine intake and serum carnitine levels with length and head circumference Z-score change and brain size at TEA were seen. In VPT infants, sufficient carnitine intake during hospitalization is necessary since it is associated with better postnatal growth and larger brain size at term age.
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Impact of Parenteral Lipid Emulsion Components on Cholestatic Liver Disease in Neonates. Nutrients 2021; 13:nu13020508. [PMID: 33557154 PMCID: PMC7913904 DOI: 10.3390/nu13020508] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 12/30/2022] Open
Abstract
Total parenteral nutrition (TPN) is a life-saving intervention for infants that are unable to feed by mouth. Infants that remain on TPN for extended periods of time are at risk for the development of liver injury in the form of parenteral nutrition associated cholestasis (PNAC). Current research suggests the lipid component of TPN is a factor in the development of PNAC. Most notably, the fatty acid composition, vitamin E concentration, and presence of phytosterols are believed key mediators of lipid emulsion driven PNAC development. New emulsions comprised of fish oil and medium chain triglycerides show promise for reducing the incidence of PNAC in infants. In this review we will cover the current clinical studies on the benefit of fish oil and medium chain triglyceride containing lipid emulsions on the development of PNAC, the current constituents of lipid emulsions that may modulate the prevalence of PNAC, and potential new supplements to TPN to further reduce the incidence of PNAC.
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López-Suárez O, Concheiro-Guisán A, Sánchez-Pintos P, Cocho JA, Fernández Lorenzo JR, Couce ML. Acylcarnitine profile in neonatal hypoxic-ischemic encephalopathy: The value of butyrylcarnitine as a prognostic marker. Medicine (Baltimore) 2019; 98:e15221. [PMID: 30985723 PMCID: PMC6485840 DOI: 10.1097/md.0000000000015221] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 03/01/2019] [Accepted: 03/20/2019] [Indexed: 11/26/2022] Open
Abstract
Optimal prognostic markers evaluating early neuroprotective interventions in neonatal hypoxic-ischemic encephalopathy (HIE) are lacking. This study was designed to assess the prognostic value of acylcarnitines in neonatal HIE.An observational cohort study was conducted over 10 years in 67 HIE. Variables analyzed included sex, blood cord pH, Apgar score, hypothermia treatment (yes/no), neuron-specific enolase (NSE) levels, and clinical outcome (neurological examination, brain magnetic resonance imaging [MRI], and electroencephalogram) before discharge and at 6 months. Acylcarnitine profiles were analyzed by tandem-mass spectrometry on dried-blood spots collected on day 3 for newborn screening. A cohort of healthy newborns was used as control group.HIE patients had significantly increased C4, C5, C5:1, C6, C6-OH, C8 levels (all P < .01) and decreased long-chain acylcarnitine levels (P < .03). Hypothermia treatment was associated with a decrease in C4 levels (p = 0.005) and an increase in most long-chain acylcarnitine levels (P < .01). A significant association was found between C4 levels and NSE on day 1 of hypothermia treatment (P = .002) and abnormal brain magnetic resonance imaging (MRI) at discharge (P = .037). In the hypothermia group, C4 levels decreased in patients with favorable outcomes but remained high in those who progressed unfavorably.C4 appears to be a good prognostic marker in HIE, as blood levels correlated with NSE levels and abnormal MRI findings. Furthermore, hypothermia did not lead to decreased levels in patients with adverse outcomes.
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Affiliation(s)
- Olalla López-Suárez
- Neonatal Unit, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela
| | - Ana Concheiro-Guisán
- Neonatal Unit, Pediatric Service, Hospital Alvaro Cunqueiro, Health Research Institute of Vigo (IVI), Vigo
| | - Paula Sánchez-Pintos
- Diagnosis and Treatment of Congenital Metabolic Diseases Unit (UDyTEMC), Department of Pediatrics, Health Research Institute of Santiago (IDIS), CIBERER, Hospital Clínico Universitario de Santiago de Compostela, Spain
| | - Jose A. Cocho
- Diagnosis and Treatment of Congenital Metabolic Diseases Unit (UDyTEMC), Department of Pediatrics, Health Research Institute of Santiago (IDIS), CIBERER, Hospital Clínico Universitario de Santiago de Compostela, Spain
| | - José R. Fernández Lorenzo
- Neonatal Unit, Pediatric Service, Hospital Alvaro Cunqueiro, Health Research Institute of Vigo (IVI), Vigo
| | - María L. Couce
- Neonatal Unit, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela
- Diagnosis and Treatment of Congenital Metabolic Diseases Unit (UDyTEMC), Department of Pediatrics, Health Research Institute of Santiago (IDIS), CIBERER, Hospital Clínico Universitario de Santiago de Compostela, Spain
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ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Lipids. Clin Nutr 2018; 37:2324-2336. [DOI: 10.1016/j.clnu.2018.06.946] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 12/24/2022]
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Jääskeläinen T, Kärkkäinen O, Jokkala J, Litonius K, Heinonen S, Auriola S, Lehtonen M, Hanhineva K, Laivuori H. A Non-Targeted LC-MS Profiling Reveals Elevated Levels of Carnitine Precursors and Trimethylated Compounds in the Cord Plasma of Pre-Eclamptic Infants. Sci Rep 2018; 8:14616. [PMID: 30279541 PMCID: PMC6168522 DOI: 10.1038/s41598-018-32804-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/14/2018] [Indexed: 11/21/2022] Open
Abstract
Preeclampsia (PE) is a complex pregnancy disorder. It is not extensively known how the metabolic alterations of PE women contribute to the metabolism of newborn. We applied liquid chromatography-mass spectrometry (LC-MS) based non-targeted metabolomics to determine whether the metabolic profile of plasma from umbilical cord differs between infants born to PE and non-PE pregnancies in the FINNPEC study. Cord plasma was available from 42 newborns born from PE and 53 from non-PE pregnancies. 133 molecular features differed between PE and non-PE newborns after correction for multiple testing. Decreased levels of 4-pyridoxic acid were observed in the cord plasma samples of PE newborns when compared to non-PE newborns. Compounds representing following areas of metabolism were increased in the cord plasma of PE newborns: urea and creatine metabolism; carnitine biosynthesis and acylcarnitines; putrescine metabolites; tryptophan metabolism and phosphatidylcholines. To our knowledge, this study is the first one to apply LC-MS based metabolomics in cord plasma of PE newborns. We demonstrate that this strategy provides a global picture of the widespread metabolic alterations associated with PE and particularly the elevated levels of carnitine precursors and trimethylated compounds appear to be associated with PE at birth.
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Affiliation(s)
- Tiina Jääskeläinen
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Olli Kärkkäinen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jenna Jokkala
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Kaisa Litonius
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Seppo Heinonen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Seppo Auriola
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Marko Lehtonen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Kati Hanhineva
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Hannele Laivuori
- Medical and Clinical Genetics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland
- Department of Obstetrics and Gynecology, Tampere University Hospital and University of Tampere, Faculty of Medicine and Life Sciences, Tampere, Finland
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Clark MA, Stein REK, Silver EJ, Khalid S, Fuloria M, Esteban-Cruciani NV. Carnitine deficiency in preterm infants: A national survey of knowledge and practices. J Neonatal Perinatal Med 2018; 10:381-386. [PMID: 29286927 DOI: 10.3233/npm-16146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Lipid supplementation improves developmental outcomes in preterm infants. Carnitine is essential for lipid metabolism; however, despite high risk for carnitine deficiency, there are no standards for carnitine supplementation in preterm infants receiving total parenteral nutrition (TPN). Our objective was to assess knowledge, beliefs and practices regarding preterm carnitine deficiency and supplementation among neonatal practitioners. METHODS Cross-sectional electronic survey administered via a nationally representative listserv of neonatal practitioners. RESULTS 492 respondents participated in the survey. Only 21% of respondents were aware that carnitine is secreted by the placenta. 72% believed that carnitine deficiency was common, and 60% believed deficiency could have serious consequences. Five percent routinely screened for deficiency, and 40% routinely provided carnitine supplementation. Respondents with >5 years' experience were more likely to report using carnitine supplementation (50% vs. 38%). CONCLUSIONS Although most respondents believed that carnitine deficiency is common and could have serious consequences, few screened for deficiency and fewer than half routinely supplemented. Thus, many preterm infants remain at risk for carnitine deficiency. Further research is needed to elucidate the risks of carnitine deficiency in these vulnerable infants.
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Affiliation(s)
- M A Clark
- UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - R E K Stein
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ellen J Silver
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sabeen Khalid
- Touro College of Osteopathic Medicine, New York, NY, USA
| | - M Fuloria
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - N V Esteban-Cruciani
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
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Clark RH, Chace DH, Spitzer AR. Impact of l-carnitine supplementation on metabolic profiles in premature infants. J Perinatol 2017; 37:566-571. [PMID: 28079870 DOI: 10.1038/jp.2016.253] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 11/20/2016] [Accepted: 12/07/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To describe the influence that of l-carnitine supplementation on acylcarnitine (AC) profiles and hospital outcomes in premature infants. STUDY DESIGN This study is a secondary analysis of previously reported work. Metabolic profiles were obtained using standard newborn techniques on infants born between 23 and 31 completed weeks of gestation. The profiles were drawn within the first 24 h after birth and on approximately days 7, 28 and 42 of life, or at the time of discharge. A single, central, contract laboratory analyzed and managed the samples. RESULTS We studied 995 patients; none was subsequently diagnosed with an inborn error of metabolism. l-Carnitine was added to parenteral nutrition in 390 (39%) study subjects; 592 (60%) did not receive supplementation. Non-supplemented infants were more likely to develop low levels of free carnitine (FC; <7 μm) on day 28; (41% vs 5%, P<0.01); and FC values were lower on day 7. Despite higher levels of FC and fewer patients with significant carnitine deficiencies, we found no evidence that l-carnitine supplementation was associated with improved short-term hospital outcomes. CONCLUSION l-Carnitine supplementation is common in prematurely born neonates and is associated with higher carnitine levels, but is not associated with improved short-term hospital outcomes.
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Affiliation(s)
- R H Clark
- Pediatrix-Obstetrix Center for Research, Education and Quality, Pediatrix Medical Group, Sunrise, FL, USA
| | - D H Chace
- Pediatrix-Obstetrix Center for Research, Education and Quality, Pediatrix Medical Group, Sunrise, FL, USA
| | - A R Spitzer
- Pediatrix-Obstetrix Center for Research, Education and Quality, Pediatrix Medical Group, Sunrise, FL, USA
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Abstract
Carnitine is synthesized endogenously from methionine and lysine in the liver and kidney and is available exogenously from a meat and dairy diet and from human milk and most enteral formulas. Parenteral nutrition (PN) does not contain carnitine unless it is extemporaneously added. The primary role of carnitine is to transport long-chain fatty acids across the mitochondrial membrane, where they undergo beta-oxidation to produce energy. Although the majority of patients are capable of endogenous synthesis of carnitine, certain pediatric populations, specifically neonates and infants, have decreased biosynthetic capacity and are at risk of developing carnitine deficiency, particularly when receiving PN. Studies have evaluated for several decades the effects of carnitine supplementation in pediatric patients receiving nutrition support. Early studies focused primarily on the effects of supplementation on markers of fatty acid metabolism and nutrition markers, including weight gain and nitrogen balance, whereas more recent studies have evaluated neonatal morbidity. This review describes the role of carnitine in metabolic processes, its biosynthesis, and carnitine deficiency syndromes, as well as reviews the literature on carnitine supplementation in pediatric nutrition.
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Affiliation(s)
- Catherine M Crill
- Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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Sánchez-Pintos P, Pérez-Muñuzuri A, Cocho JÁ, Fernández-Lorenzo JR, Fraga JM, Couce ML. Evaluation of carnitine deficit in very low birth weight preterm newborns small for their gestational age. J Matern Fetal Neonatal Med 2015; 29:933-7. [PMID: 25777790 DOI: 10.3109/14767058.2015.1024647] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To verify whether small-for-gestational-age (SGA) preterm newborns represent a special risk group for carnitine deficiency. Secondary outcome includes assessment of longitudinal differences of total carnitine (TC), free carnitine (FC) and acylcarnitines between SGA and appropriate-for-gestational-age (AGA). METHODS A retrospective study to evaluate carnitine and acylcarnitines profile on 144 very-low-birth weight newborns (VLBW), classified as AGA (n = 73) and SGA (n = 71), was performed by tandem mass spectrometry, during their first 5 weeks of life. Carnitine deficiency was defined as FC <40 µmol/L and FC/TC <0.7. RESULTS Carnitine deficiency was observed in the two study groups throughout the monitoring period (maximum FC: 36.05 µmol/L in AGA and 32.24 µmol/L in SGA). FC/TC remains under 0.7 in both with progressive improvement. Unlike expected, a comparatively higher value of TC, FC and total acylcarnitines (tAC) was found in SGA during the first 2 weeks, with significant relevance on day 3-5, especially for tAC (p < 0.001). The only acylcarnitine with persistently lower value in SGA is C5 (p < 0.05 in first 2 weeks). CONCLUSIONS A carnitine deficiency was demonstrated in all VLBW. Although birth weight restriction has been suggested as a risk factor for impaired carnitine status, in our study, SGA was not related with higher carnitine deficiency.
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Affiliation(s)
| | - Alejandro Pérez-Muñuzuri
- b Neonatal Unit, Department of Pediatrics , Complexo Hospitalario Universitario de Santiago de Compostela , Santiago de Compostela , Spain
| | - Jose Ángel Cocho
- c Diagnosis and Treatment Unit of Metabolic Diseases , Complexo Hospitalario Universitario de Santiago de Compostela , Santiago de Compostela , Spain , and
| | | | - Jose María Fraga
- b Neonatal Unit, Department of Pediatrics , Complexo Hospitalario Universitario de Santiago de Compostela , Santiago de Compostela , Spain .,c Diagnosis and Treatment Unit of Metabolic Diseases , Complexo Hospitalario Universitario de Santiago de Compostela , Santiago de Compostela , Spain , and
| | - Maria L Couce
- b Neonatal Unit, Department of Pediatrics , Complexo Hospitalario Universitario de Santiago de Compostela , Santiago de Compostela , Spain .,c Diagnosis and Treatment Unit of Metabolic Diseases , Complexo Hospitalario Universitario de Santiago de Compostela , Santiago de Compostela , Spain , and
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Neves A, Pereira-da-Silva L, Fernandez-Llimos F. [Neonatal parenteral nutrition prescription practices in Portugal]. An Pediatr (Barc) 2013; 80:98-105. [PMID: 23831203 DOI: 10.1016/j.anpedi.2013.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 04/17/2013] [Accepted: 05/19/2013] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The use of guidelines for neonatal parenteral nutrition (PN) improves its clinical efficiency and the safety of prescription. OBJECTIVE To evaluate the practices of neonatal parenteral nutrition prescription in Portugal, and the adherence to the National Consensus on neonatal PN (2008). METHODS A questionnaire based on a multiple choice response on parenteral nutrition prescription was conducted, and sent to the coordinators of the 50 public and private Portuguese neonatal special care units, 25 being level III and 25 level II. RESULTS Parenteral nutrition was prescribed in 32 neonatal units, 23 of which (71.9%) responded to the questionnaire. Of the respondents, 19 (82.6%) refer to follow the National Consensus, the remaining following local guidelines; 17 (73.9%) of units referred to using an electronic based system for prescription. In preterm neonates, most mentioned: administering judiciously the fluid intake during the first post-natal week; starting amino acids from the first post-natal day with 1.5-3g/kg/d, increasing up to 3-4g/kg/d; starting lipids from the first three post-natal days with 1g/kg/d, increasing up to 3g/kg/d; administering 40-70mg/kg/d of calcium and of phosphorus with the fixed calcium:phosphorus ratio of 1.7: 1 (mg:mg); and estimating the osmolality of the solutions, and weekly monitoring of serum triglycerides, blood urea, serum phosphorus and liver function. CONCLUSIONS The high response rate is probably representative of the practice of PN prescription in Portugal. Most of the units used the National Consensus on neonatal PN as a reference, thus contributing to better nutritional support for neonates.
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Affiliation(s)
- A Neves
- Servicios Farmacéuticos, Hospital da Luz, Lisboa, Portugal
| | - L Pereira-da-Silva
- Unidad de Cuidados Intensivos Neonatales, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa, Portugal; Departamento de Pediatría, Facultad de Ciencias Médicas, Universidad Nova de Lisboa, Lisboa, Portugal
| | - F Fernandez-Llimos
- Departamento de Farmacia Social, Facultad de Farmacia, Universidad de Lisboa, Lisboa, Portugal.
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Tokuriki S, Hayashi H, Okuno T, Yoshioka K, Okazaki S, Kawakita A, Ohta G, Hata I, Shigematsu Y, Ohshima Y. Biotin and carnitine profiles in preterm infants in Japan. Pediatr Int 2013; 55:342-5. [PMID: 23316835 DOI: 10.1111/ped.12053] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 12/16/2012] [Accepted: 12/27/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Biotin plays an important role as a covalently bound coenzyme for carboxylases. Carnitine is essential in β-oxidation to transport long-chain fatty acids across the inner mitochondrial membrane. The present study was conducted to assess the risk of biotin and carnitine deficiencies in preterm infants who received enteral feeding with maternal milk and/or standard infant formula made in Japan. METHODS Forty-six infants were enrolled in the study. Urine and serum samples and dried blood spots were collected at 1 week and 1 month of age. Additionally, samples were collected at 40 and 44 weeks post-menstrual age (PMA) in preterm infants. Free carnitine and C5-OH acylcarnitine, which consist of 3-hydroxyisovalerylcarnitine as a major isomer, were measured in serum samples and dried blood spots using tandem mass spectrometry. Urine 3-hydroxyisovaleric acid (3-HIVA) was measured using gas chromatography/mass spectrometry. RESULTS The free carnitine levels in preterm infants were significantly lower than those in term infants, but increased with PMA in serum samples and dried blood spots. C5-OH acylcarnitine and urinary 3-HIVA levels, which were very low in term infants, were increased with PMA in preterm infants. CONCLUSION The present results may indicate chronic biotin deficiency in preterm infants fed maternal milk and/or standard infant formula. Analyses of carnitine profiles of dried blood spots and urine 3-HIVA are relatively non-invasive and useful for the early detection of biotin deficiency in preterm infants.
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Affiliation(s)
- Shuko Tokuriki
- Department of Pediatrics, University of Fukui, Fukui, Japan.
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Crill CM, Storm MC, Christensen ML, Hankins CT, Bruce Jenkins M, Helms RA. Carnitine supplementation in premature neonates: Effect on plasma and red blood cell total carnitine concentrations, nutrition parameters and morbidity. Clin Nutr 2006; 25:886-96. [PMID: 16808989 DOI: 10.1016/j.clnu.2006.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2005] [Revised: 05/01/2006] [Accepted: 05/02/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND & AIMS Carnitine may be considered conditionally essential in the neonatal population. The purpose of this study was to evaluate the effects of long-term carnitine supplementation on total carnitine status and morbidity in premature neonates. METHODS In this prospective, randomized, placebo-controlled, double-blinded study, premature neonates received carnitine supplementation (20mg/kg/day) or placebo. Plasma (nmol/ml) and red blood cell (RBC) (nmol/mg hemoglobin) total carnitine concentrations, 24-h nitrogen excretion, intake and weight, and respiratory, gastroesophageal, and infectious morbidity were assessed. RESULTS Twenty-nine neonates (13 placebo, 16 carnitine; 27+/-2 weeks gestation; 976+/-259g birthweight) were studied for up to 8 weeks. Plasma total carnitine concentrations exceeded the reference range in the carnitine group (weeks 1-8); however, concentrations did not reach reference range until week 4 in the placebo group. RBC total carnitine concentrations increased, but remained below reference range in both the carnitine (weeks 1-6) and placebo (weeks 1-8) groups. Carnitine group neonates regained their birthweight more rapidly than placebo group neonates (day of life 11.8+/-6 vs. 16.9+/-6.3, P=0.034). In addition, percent periodic breathing calculated from cardiopulmonary trend monitor data (weeks 1-8) was lower in the carnitine group (0.4+/-0.9 vs. 1.4+/-1.9, P=0.014). There was no difference with respect to other markers of respiratory, gastroesophageal and infectious morbidity or nitrogen balance. CONCLUSIONS Carnitine supplementation at 20mg/kg/day results in increased plasma and RBC total carnitine concentrations, has a positive effect on catch-up growth, and may improve periodic breathing in premature neonates.
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Affiliation(s)
- Catherine M Crill
- Department of Pharmacy, The University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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Abstract
BACKGROUND Apnea of prematurity is a common problem in preterm infants in the neonatal intensive care setting (NICU), often delaying their discharge home or transfer to a step down unit. Premature infants are at increased risk of carnitine deficiency. Carnitine supplementation has been used for both prevention and treatment of apnea. OBJECTIVES To determine whether treatment with carnitine will reduce the frequency of apnea, the duration of ventilation and the duration of hospital stay in preterm infants with recurrent apnea. SEARCH STRATEGY Computerised searches were carried out by two reviewers independently. Searches were made of MEDLINE (1966 to May 2004), EMBASE (1980 to May 2004), CINAHL (1982-2004 June 2004,1st week), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2004), abstracts of annual meetings of the Society for Pediatric Research (1995-2004), and contacts were made with the subject experts. SELECTION CRITERIA Only randomized or quasi-randomized treatment trials of preterm infants with a diagnosis of recurrent apnea of prematurity were considered. Trials were included if they involved treatment with carnitine compared to placebo or no treatment, and measured at least one of the following outcomes: failure of resolution of apneas, the duration of ventilation and the duration of hospital stay. DATA COLLECTION AND ANALYSIS Two reviewers evaluated the papers for inclusion criteria and quality. Corresponding authors were contacted for further information where needed. MAIN RESULTS No eligible trials were identified. REVIEWERS' CONCLUSIONS Despite the plausible rationale for the treatment of apnea of prematurity with carnitine, there are insufficient data to support its use for this indication. Further studies are needed to determine the role of this treatment in clinical practice.
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Affiliation(s)
- M Kumar
- Department of Pediatrics, McMaster Children's Hospital, 1200 Main Street West, Hamilton, L8S 3Z5, Ontario, Canada.
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