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ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Amino acids. Clin Nutr 2018; 37:2315-2323. [DOI: 10.1016/j.clnu.2018.06.945] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 02/02/2023]
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Leenders EKSM, de Waard M, van Goudoever JB. Low- versus High-Dose and Early versus Late Parenteral Amino-Acid Administration in Very-Low-Birth-Weight Infants: A Systematic Review and Meta-Analysis. Neonatology 2018; 113:187-205. [PMID: 29268262 DOI: 10.1159/000481192] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 09/04/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Providing parenteral amino acids to very-low-birth-weight infants during the first weeks of life is critical for adequate growth and neurodevelopment. However, there is no consensus about what dose is appropriate or when to initiate supplementation. As a result, daily practice varies among neonatal intensive care units. The objective of our study was to determine the effects of early parenteral amino-acid supplementation (within 24 h of birth) versus later initiation and high dose (>3.0 g/kg/day) versus a lower dose on growth and morbidities. METHODS A systematic review and meta-analysis of publications identified by searching PubMed, EMBASE, and Cochrane databases was conducted. Randomized controlled studies were eligible if information on growth was available. RESULTS The search identified 14 studies. No differences were observed in growth or morbidity after early or high-dose amino-acid supplementation, but for several outcomes, meta-analysis was not possible due to study heterogeneity. Initiation of amino acids within the first 24 h of life appeared to be safe and well tolerated, and leads more rapidly to a positive nitrogen balance. CONCLUSIONS Administering a high dose (>3.0 g/kg/day) or an early dose (≤24 h) of parenteral amino acids is safe and well tolerated but does not offer significant benefits on growth. Further large-scale randomized controlled trials in preterm infants are needed to study the effects of early and high-dose amino acids on growth and morbidity more consistently and extensively.
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Affiliation(s)
- Erika K S M Leenders
- Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands
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Riskin A. Meeting the nutritional needs of premature babies: their future is in our hands. Br J Hosp Med (Lond) 2017; 78:690-694. [PMID: 29240511 DOI: 10.12968/hmed.2017.78.12.690] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The goals of early nutrition in preterm infants are to provide all the necessary vital nutrients, achieve extra-uterine growth rates similar to fetuses of the same gestational age, and support functional neurodevelopmental outcomes that are comparable to those of infants born at term. It is vital to provide nutrition that will maximally support brain growth and development, but over-feeding with accelerated growth, fat accumulation and long-term metabolic consequences should also be avoided. Because the morbidity associated with prematurity increases nutritional and energetic demands, the basic approach is of providing early intensive nutrition. Protein is the main driving force for growth and brain development. Since deficits in protein occur from the first day of extra-uterine life, sufficient quantities of parenteral amino acids should be provided from the first hours of life. With protein and carbohydrates, enough energy should also be provided, via concomitant early administration of intravenous lipid emulsions. Early initiation of enteral feeding with advancement to full enteral nutrition is associated with better maturation of the gut and better neuro-developmental outcomes. Human milk is the best food for preterm babies, although enrichment may be needed.
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Affiliation(s)
- Arieh Riskin
- Department of Neonatology, Bnai Zion Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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Franco KA, O'Mara K. Impact of Computerized Provider Order Entry on Total Parenteral Nutrition in the Neonatal Intensive Care Unit. J Pediatr Pharmacol Ther 2016; 21:339-345. [PMID: 27713674 DOI: 10.5863/1551-6776-21.4.339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES: To determine if computerized provider order entry (CPOE) implementation impacts the time it takes for preterm neonates to reach their parenteral macronutrient goals. METHODS: Retrospective review of neonates <1750 g receiving parenteral nutrition (PN) before and after the implementation of CPOE. Primary outcome was the attainment of parenteral macronutrient goals. Secondary outcomes included time to attainment, the frequency of electrolyte abnormalities, and the incidence of required adjustments made to PN orders by verification pharmacists. RESULTS: Goal PN was achieved by 12/47 (25.5%) intervention vs. 2/44 (4.5%) control group infants (p < 0.05). This goal was attained in 10.8 ± 7.5 days in the intervention group and 10 ± 4.2 days in the control group (p = 0.90). Goal protein was reached by 74.5% of CPOE patients vs. 36.4% of controls, p < 0.05. Lipid goals were achieved by 98% vs. 100% (p = 0.33) of patients and were attained at an average of 1.5 ± 0.8 days vs. 2.0 ± 1.1 days (p < 0.05). Abnormal serum electrolyte values occurred more frequently in the control group (0.79 vs. 1.12/day PN). Adjustments by a verification pharmacist were required in 5.6% of CPOE compared with 30.4% of control group orders (p < 0.05). CONCLUSIONS: CPOE parenteral nutrition increased the proportion of preterm neonates attaining overall macronutrient goals. With CPOE, protein goals were reached by more patients and goal lipids were achieved faster. This system also decreased the number of pharmacist interventions during verification of PN orders and appeared to positively impact the incidence of serum electrolyte disturbances.
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Affiliation(s)
- Kyle A Franco
- University of Florida Health Shands Hospital, Gainesville, Florida
| | - Keliana O'Mara
- University of Florida Health Shands Hospital, Gainesville, Florida
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Early Postnatal Growth in a Subset of Convalescing Extremely-Low-Birth-Weight Neonates: Approximating the "Index Fetus" Ex Utero. J Pediatr Gastroenterol Nutr 2015; 61:361-6. [PMID: 25651485 DOI: 10.1097/mpg.0000000000000750] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate whether a subset of noncritically ill, convalescing extremely-low-birth-weight neonates who were managed using a standardized nutritional protocol could achieve the growth rate of the index fetus. We hypothesized that an aggressive nutritional protocol applied to noncritically ill, convalescing premature neonates could achieve the growth rate of the index fetus. METHODS This was a retrospective review of a subset of 21 premature neonates defined by 4 criteria: inborn or transferred-in within 24 hours of birth, gestational age < 30 weeks and birth weight ≤1000 g, hospitalized >35 postnatal days, and discharged between 34 and 42 weeks postconceptual age. Optimal growth at discharge was defined as weight and head circumference >10th percentile compared with comparable gestational age fetal parameters. RESULTS Protein intake of ≥1.4 g · kg · day and energy ≥30 kcal · kg · day were provided as of the first postnatal day. Proteins ≥3 g · kg · day and >80 kcal · kg · day were established ≥10th postnatal day. Birth weight was regained by postnatal day 10 ± 5 day (mean + standard deviation). Nutrition was predominantly enteral (ie, >50% of all calories) after the 11th postnatal day. At discharge, 71% (15/21) by weight and 76% (16/21) by head circumference were >10th percentile. After 30 weeks postconceptual age, the cohort exceeded the weight gain rate (g/wk) of a 10th-percentile fetus. CONCLUSIONS In a selected subset of noncritically ill, convalescing extremely-low-birth-weight neonates, after a brief period of unavoidable postnatal weight loss and body water adjustment, adequate nutrition from birth can enable a more homeostatic pattern of growth that approximates growth of the index fetus.
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Moe K, Beck-Nielsen SS, Lando A, Greisen G, Zachariassen G. Administering different levels of parenteral phosphate and amino acids did not influence growth in extremely preterm infants. Acta Paediatr 2015; 104:894-9. [PMID: 26046292 DOI: 10.1111/apa.13063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/27/2015] [Accepted: 06/01/2015] [Indexed: 01/01/2023]
Abstract
AIM When a new high amino acid parenteral nutrition (PN) solution was introduced to our hospital, a design error led to decreased phosphate levels. This prompted us to examine the effect of three different PN solutions on plasma phosphate, plasma calcium and weight increases on extremely preterm infants. METHOD This was a retrospective study of 186 infants with a gestational age of <28 weeks during their first month of life. They were divided into three groups based on the PN they received during hospitalisation. Group one received high levels of phosphate and low levels of amino acids. Group two received low levels of phosphate and high levels of amino acids. Group three received high levels of both phosphate and amino acids. RESULTS The lowest plasma phosphate values varied significantly between groups one (1.80 ± 0.46 mmol/L), two (1.05 ± 0.48 mmol/L) and three (1.40 ± 0.37 mmol/L) (p < 0.001), but no significant difference in weight increase was seen (p = 0.497). CONCLUSION The phosphate content of the PN influenced plasma phosphate and plasma calcium levels, but increasing the levels of both phosphate and amino acids did not improve weight gain during the first month of life.
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Affiliation(s)
- Katrine Moe
- University of Copenhagen; Copenhagen Denmark
| | | | - Ane Lando
- Department of Neonatology; JMC; Rigshospitalet - Copenhagen University Hospital; Copenhagen Denmark
| | - Gorm Greisen
- Department of Neonatology; JMC; Rigshospitalet - Copenhagen University Hospital; Copenhagen Denmark
| | - Gitte Zachariassen
- Hans Christian Andersen Children′s Hospital; Odense University Hospital; Odense Denmark
- Department of Neonatology; JMC; Rigshospitalet - Copenhagen University Hospital; Copenhagen Denmark
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Lee BS. Nutritional strategy of early amino acid administration in very low birth weight infants. KOREAN JOURNAL OF PEDIATRICS 2015; 58:77-83. [PMID: 25861329 PMCID: PMC4388974 DOI: 10.3345/kjp.2015.58.3.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/16/2015] [Indexed: 01/30/2023]
Abstract
Relative to a fetus of the same gestational age, very low birth weight (VLBW) infants are more likely to be underfed and to undergo growth restriction during their early hospital stay. The current trend towards "early and aggressive" nutritional strategies in VLBW infants aims to overcome the early nutritional deficiency and thereby boost postnatal catch-up growth, simultaneously improving long-term neurodevelopmental outcomes. Although the minimum starting amino acid (AA) dose to prevent negative nitrogen balance is well established, the upper limit and the rate of increase of early AA doses are controversial. Most randomized controlled trials show that early and high-dose (target, 3.5 to 4.9 g/kg/day) AA regimens, with or without high nonprotein calories, do not improve long-term growth and neurodevelopment. High-dose AA supplementation may lead to early metabolic disturbances and excessive or disproportionate plasma AA levels, particularly in infants of very low gestational age. Further large studies are needed to clarify the optimal strategy for early administration of parenteral AA doses in VLBW infants.
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Affiliation(s)
- Byong Sop Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Baudouin A, Diouf E, Tall ML, Duval S, Provôt S, Picaud JC, Claris O, Pivot C, Pirot F. Avantages et spécificités des préparations hospitalières de nutrition parentérale en néonatalogie. ANNALES PHARMACEUTIQUES FRANÇAISES 2015; 73:150-9. [DOI: 10.1016/j.pharma.2014.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 06/06/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
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Kim MY, Chang EJ, Kim YH, Jang WJ, Cho HJ, Lee JS, Son DW. The Impact of Fluid Therapy Strategies on Nonoliguric Hyperkalemia in Extremely Low Birth Weight Infants. NEONATAL MEDICINE 2014. [DOI: 10.5385/nm.2014.21.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Min Young Kim
- Department of Pediatrics, Graduate School of Medicine, Gachon University, Incheon, Korea
| | - Eun Jae Chang
- Department of Pediatrics, Graduate School of Medicine, Gachon University, Incheon, Korea
| | - Young Hye Kim
- Department of Anesthesiology, Incheon Saint Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | - Woo Jung Jang
- Department of Pediatrics, Graduate School of Medicine, Gachon University, Incheon, Korea
| | - Hye Jung Cho
- Department of Pediatrics, Graduate School of Medicine, Gachon University, Incheon, Korea
| | - Ji Sung Lee
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Gachon University, Incheon, Korea
| | - Dong Woo Son
- Department of Pediatrics, Graduate School of Medicine, Gachon University, Incheon, Korea
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Burattini I, Bellagamba MP, Spagnoli C, D'Ascenzo R, Mazzoni N, Peretti A, Cogo PE, Carnielli VP. Targeting 2.5 versus 4 g/kg/day of amino acids for extremely low birth weight infants: a randomized clinical trial. J Pediatr 2013; 163:1278-82.e1. [PMID: 23941670 DOI: 10.1016/j.jpeds.2013.06.075] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 05/03/2013] [Accepted: 06/27/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the effect of 2.5 vs 4 g/kg/d of amino acid (AA) in parenteral nutrition of extremely low birth weight infants on metabolic tolerance, short-term growth, and neurodevelopment. STUDY DESIGN One hundred thirty-one infants with birth weight between 500 and 1249 g were randomized to 2.5 (standard AA [SAA] group) or 4 (high AA [HAA] group) g/kg/d AA intake, with equal nonprotein energy. The primary outcome was body size at 36 weeks. RESULTS One hundred thirty-one patients were randomized and 114 analyzed (58 SAA group and 56 HAA group). Study groups had similar demographics and clinical characteristics. Elevated blood urea (BU >70 mg/dL = BU nitrogen >32.6 mg/dL) occurred in 24% vs 59% (P = .000) and hyperglycemia (>175 mg/dL) in 34% vs 11% (P = .003) of the SAA and HAA patients, respectively. Body weight, length, and head circumference at 36 weeks and 2 years were similar between groups. Bayley Scales of Infant and Toddler Development, Third Edition score was 94 ± 13 in the SAA group and 97 ± 15 in the HAA group (P = .35). CONCLUSIONS The HAA group had higher BU levels and better glucose control. An extra 8 g/kg of AA over the first 10 days of life did not improve growth and neurodevelopment.
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Affiliation(s)
- Ilaria Burattini
- Division of Neonatology, Department of Mother and Child Health, Ospedale Salesi-Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy.
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Parenteral amino acid intakes: possible influences of higher intakes on growth and bone status in preterm infants. J Perinatol 2013; 33:33-9. [PMID: 22517036 DOI: 10.1038/jp.2012.44] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To study the possible influences of amino acid (AA) intakes on growth and bone status in preterms. STUDY DESIGN Newborns, weighing <1250 g, received standard (S) or higher (H) parenteral AA intakes (3 or 4 g kg(-1) per day). Anthropometry, biochemistry and quantitative ultrasound (metacarpus bone transmission time (mcBTT), in μs) were measured prospectively. RESULT A total of 55 patients in group S and 60 in group H were studied. Significantly better growth rate was found in the H group during the study without signs of intolerance. We found a significant decrease in mcBTT from birth to 21 days in the H group; nonetheless, mcBTT at 36 weeks of gestational age significantly positively correlated with early AA and energy intakes. A significant positive correlation between mcBTT and lower limb length (LLL) at 21 days was found. CONCLUSION Early higher AA intakes improved growth without short-term AA intolerance. Nutritional parameters could influence bone growth. LLL was the anthropometric parameter that best correlated to bone status.
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Alsweiler JM, Harding JE, Bloomfield FH. Neonatal hyperglycaemia increases mortality and morbidity in preterm lambs. Neonatology 2013; 103:83-90. [PMID: 23128645 DOI: 10.1159/000342240] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 07/30/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hyperglycaemic preterm babies suffer increased mortality and morbidity, but it is not known if these associations are causal or if treatment with insulin improves outcome. OBJECTIVES We aimed to investigate the effect of neonatal hyperglycaemia, and its treatment with insulin, on mortality and morbidity in preterm lambs. METHODS Preterm lambs (137 days' gestation; term = 148 days) were randomised to a 12-day intravenous infusion of saline (PremC; n = 39), 50% dextrose (HYPER; n = 47), or 50% dextrose + insulin (INS; n = 21). Term controls (TermC; n = 19) received saline. Dextrose and insulin infusions were titrated to maintain blood glucose concentrations (BGC) at 10-12 mmol·l(-1) (HYPER) or 4-6 mmol·l(-1) (INS). RESULTS HYPER lambs had higher BGC (mean (SEM); TermC: 5.6 (0.1), PremC: 5.5 (0.1), HYPER: 10.8 (0.6), INS: 6.2 (0.3) mmol·l(-1); p < 0.0001), higher mortality (n (%); TermC: 0, PremC: 2 (5), HYPER: 11 (23), INS: 0; p < 0.001), higher incidence of fever (n (%); TermC: 3 (16), PremC: 13 (33), HYPER: 26 (55), INS: 6 (29); p = 0.01) and lower weight gain (mean (SEM); TermC: 45.9 (2.9), PremC: 44.2 (2.1), HYPER: 28.4 (1.9), INS: 28.7 (2.8) g·kg(-1)·day(-1); p < 0.0001). CONCLUSIONS Neonatal hyperglycaemia in preterm lambs causes increased mortality and morbidity, and decreases growth. Insulin treatment to restore euglycaemia attenuated the increased mortality and morbidity, but not the decreased growth.
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Affiliation(s)
- Jane M Alsweiler
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
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Blood Urea Nitrogen Concentration and Aggressive Parenteral Amino Acid Administration in Extremely Low Birth Weight Infants during the First Week. ACTA ACUST UNITED AC 2013. [DOI: 10.14734/kjp.2013.24.1.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Can E, Bülbül A, Uslu S, Cömert S, Bolat F, Nuhoğlu A. Effects of aggressive parenteral nutrition on growth and clinical outcome in preterm infants. Pediatr Int 2012; 54:869-74. [PMID: 22882288 DOI: 10.1111/j.1442-200x.2012.03713.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 05/09/2012] [Accepted: 08/03/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND The goal of nutrition in the preterm infant is to achieve postnatal growth approximating normal fetal growth. During the early postnatal period, protein intake must be sufficient to achieve normal postnatal growth in extremely low-birthweight infants. The aim of this study was to test the hypothesis that giving higher amounts of amino acids and lipids to infants born at <34 gestational weeks (GW) may improve growth at the 40th week of gestation and have a positive preventive effect on development of retinopathy of prematurity (ROP). METHODS Fifty-three neonates born at <34 GW and hospitalized in the neonatal intensive care unit (NICU) were included in this prospective study. They were randomly divided into two groups. Group 1 received aggressive parenteral nutrition (PN) (amino acids 3 g/kg per day and lipids 2 g/kg per day on first day of life). Group 2 received conventional PN (amino acids 1.5 g/kg per day and lipids 1 g/kg per day on first day of life). The anthropometric measurements, clinical outcomes and serum levels of insulin-like growth factor-I (IGF-I), IGF binding protein (IGFBP) and thyroid hormones were compared between groups. RESULTS At 40 weeks of gestation, height, head circumference and serum IGF-I and IGFBP3 were statistically higher in the group receiving aggressive PN. Thyroid hormones were not affected by aggressive PN. The lower levels of IGF-I and IGFBP3 in the group receiving conventional PN were negatively correlated with development of ROP. CONCLUSION Aggressive PN seems to positively affect neonates' anthropometric measurements at the 40th gestational week and the development of ROP. These effects may be related to high levels of IGF-I and IGFBP3.
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Affiliation(s)
- Emrah Can
- Department of Pediatrics, Division of Neonatology, Sisli Etfal Children's Hospital, Istanbul, Turkey.
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Yang S, Lee BS, Park HW, Choi YS, Jeong SH, Kim JH, Kim EAR, Kim KS. Effect of High vs Standard Early Parenteral Amino Acid Supplementation on the Growth Outcomes in Very Low Birth Weight Infants. JPEN J Parenter Enteral Nutr 2012; 37:327-34. [DOI: 10.1177/0148607112456400] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sami Yang
- Asan Medical Center, Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Sop Lee
- Asan Medical Center, Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye-Won Park
- Department of Pediatrics, Division of Neonatology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea
| | - Yong-Sung Choi
- Asan Medical Center, Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong-Hun Jeong
- Asan Medical Center, Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji-Hee Kim
- Asan Medical Center, Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
| | - Ellen Ai-Rhan Kim
- Asan Medical Center, Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Soo Kim
- Asan Medical Center, Department of Pediatrics, University of Ulsan College of Medicine, Seoul, Korea
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Cormack BE, Bloomfield FH, Dezoete A, Kuschel CA. Does more protein in the first week of life change outcomes for very low birthweight babies? J Paediatr Child Health 2011; 47:898-903. [PMID: 21658149 DOI: 10.1111/j.1440-1754.2011.02106.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Following publication of revised recommended nutrient intakes (RNI) for infants <1500 g, our intravenous nutrition (IVN) solutions were reformulated to deliver RNI in a restricted volume to ensure additional non-nutritional fluids did not detract from nutritional intake. An audit was performed to determine whether these changes achieved RNI and influenced growth, clinical or neurodevelopmental outcomes. METHODS Two cohorts of 40 infants <1500 g were identified from a prospectively maintained database: babies born before and after reformulation of the IVN solutions. Data on nutritional intakes for the first 30 days of life, growth and clinical outcomes were collected. Neurodevelopmental outcomes at 18 months corrected age (CA) were obtained from a Bayley III assessment. Results are presented as mean ± SD. RESULTS The 'after' group received significantly less fluid (105 ± 12 vs. 132 ± 15 mL/kg/day, P < 0.001) but more protein (3.2 ± 0.6 vs. 2.4 ± 0.5 g/kg/day, P < 0.001) in the first week of life. There were no differences in clinical outcome, growth z-scores at 4 weeks of age or neurodevelopmental outcome at 18 months CA between the 'before' and 'after' infants. Enteral protein intake in the first 2 weeks of life was positively associated with neurodevelopmental outcome (cognitive score r(2) = 0.13 P= 0.03, motor score r(2) = 0.27 P= 0.001). CONCLUSION Although the new IVN regimen achieved intakes closer to RNI, there were no major effects on growth, clinical outcome or neurodevelopmental outcome at 18 months CA. Enteral protein intake in the first two weeks was positively associated with neurodevelopmental outcome, suggesting early enteral protein intake is important for optimal brain function.
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Affiliation(s)
- Barbara E Cormack
- National Women's Health, Auckland City Hospital, Auckland, New Zealand.
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García LV, Erroz IO, Freire MM, Muñuzuri AP, Souto AB, Pico MLC, Bermúdez JMF. [Does early parenteral protein intake improve extrauterine growth in low birth weight preterms?]. An Pediatr (Barc) 2011; 76:127-32. [PMID: 22056312 DOI: 10.1016/j.anpedi.2011.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 04/05/2011] [Accepted: 04/07/2011] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Extrauterine growth restriction affects most premature newborns. Early and higher parenteral protein intake seems to improve postnatal growth and associated comorbidities. We evaluate the impact of a new parenteral nutrition protocol based on early amino acid administration on postnatal growth in premature infants with a birth weight < 1,500 grams. MATERIAL AND METHODS A case-control study in 58 premature newborns with a birth weight < 1,500 grams. In the case group we included 29 preterm neonates who received at least 1.5 g/kg/day parenteral amino acid during the first 24 hours after birth, reaching a maximum dose of 3.5 g/kg/day on the 3(rd)-4(th) day after birth. The control group was formed by 29 preterm neonates for whom protein support began on the 2(nd-)3(rd) day after birth with a dose of 1g/kg/day with lower daily increases than the case group. Growth rates and complications were followed until 28 days of life or discharge from NICU. RESULTS There were no differences between groups in baseline characteristics. Premature newborns who received higher and earlier doses of proteins had a greater weight gain than the control group, and this difference was statistically significant (423 ± 138 g vs. 315 ± 142 g; P=.005). In addition, they had a higher daily weight gain rate (19.4 ± 3.3 vs. 16.5 ± 4.8; P=.010) and they regained birth weight earlier (11.5 ± 3.3 days vs. 14.5 ± 4.5 days; P=.045). A higher incidence of complications was not observed. CONCLUSIONS Early and higher amino acid administration improves growth rate in premature neonates with no apparent increase in risks for the patient.
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Affiliation(s)
- L Vázquez García
- Servicio de Neonatología, Departamento de Pediatría, Hospital Clínico Universitario de Santiago de Compostela, A Coruña, España.
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SCAMP: standardised, concentrated, additional macronutrients, parenteral nutrition in very preterm infants: a phase IV randomised, controlled exploratory study of macronutrient intake, growth and other aspects of neonatal care. BMC Pediatr 2011; 11:53. [PMID: 21663622 PMCID: PMC3141505 DOI: 10.1186/1471-2431-11-53] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 06/10/2011] [Indexed: 11/29/2022] Open
Abstract
Background Infants born <29 weeks gestation are at high risk of neurocognitive disability. Early postnatal growth failure, particularly head growth, is an important and potentially reversible risk factor for impaired neurodevelopmental outcome. Inadequate nutrition is a major factor in this postnatal growth failure, optimal protein and calorie (macronutrient) intakes are rarely achieved, especially in the first week. Infants <29 weeks are dependent on parenteral nutrition for the bulk of their nutrient needs for the first 2-3 weeks of life to allow gut adaptation to milk digestion. The prescription, formulation and administration of neonatal parenteral nutrition is critical to achieving optimal protein and calorie intake but has received little scientific evaluation. Current neonatal parenteral nutrition regimens often rely on individualised prescription to manage the labile, unpredictable biochemical and metabolic control characteristic of the early neonatal period. Individualised prescription frequently fails to translate into optimal macronutrient delivery. We have previously shown that a standardised, concentrated neonatal parenteral nutrition regimen can optimise macronutrient intake. Methods We propose a single centre, randomised controlled exploratory trial of two standardised, concentrated neonatal parenteral nutrition regimens comparing a standard macronutrient content (maximum protein 2.8 g/kg/day; lipid 2.8 g/kg/day, dextrose 10%) with a higher macronutrient content (maximum protein 3.8 g/kg/day; lipid 3.8 g/kg/day, dextrose 12%) over the first 28 days of life. 150 infants 24-28 completed weeks gestation and birthweight <1200 g will be recruited. The primary outcome will be head growth velocity in the first 28 days of life. Secondary outcomes will include a) auxological data between birth and 36 weeks corrected gestational age b) actual macronutrient intake in first 28 days c) biomarkers of biochemical and metabolic tolerance d) infection biomarkers and other intravascular line complications e) incidence of major complications of prematurity including mortality f) neurodevelopmental outcome at 2 years corrected gestational age Trial registration Current controlled trials: ISRCTN76597892; EudraCT Number: 2008-008899-14
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van den Akker CHP, Vlaardingerbroek H, van Goudoever JB. Nutritional support for extremely low-birth weight infants: abandoning catabolism in the neonatal intensive care unit. Curr Opin Clin Nutr Metab Care 2010; 13:327-35. [PMID: 20216411 DOI: 10.1097/mco.0b013e328337d925] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Obviously, the ultimate goal in neonatology is to achieve a functional outcome in premature infants that is comparable to healthy term-born infants. As nutrition is one of the key factors for normal cell growth, providing the right amount and quality of nutrients could prove pivotal for normal development. However, many premature infants are catabolic during the first week of life, which has directly been linked to growth failure, disease, and suboptimal long-term outcome. This review describes the progress in research on parenteral nutrition for premature infants with a focus on amino acids and the influence of nutrition on later outcome. RECENT FINDINGS Although randomized clinical trials on early nutrition for premature infants remain relatively sparse, evidence is accumulating on its beneficial effects both on the short-term and long-term. However, some research also warns for adverse effects. SUMMARY Despite the fact that substantially improved nutritional therapies for preterm neonates have been implemented, still, some reluctance exists when it comes to providing high amounts of nutrition to the most immature infants. Pros and cons are outlined, as well as deficits in knowledge, when it comes to providing the optimal nutrient strategy in the first postnatal phase.
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Affiliation(s)
- Chris H P van den Akker
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
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20
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Herrmann KR, Herrmann KR. Early Parenteral Nutrition and Successful Postnatal Growth of Premature Infants. Nutr Clin Pract 2010; 25:69-75. [DOI: 10.1177/0884533609359001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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21
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Improving early protein intake for very preterm infants using a standardised concentrated parenteral nutrition formulation. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.eclnm.2009.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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22
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Berkemeyer S. Acid-base balance and weight gain: are there crucial links via protein and organic acids in understanding obesity? Med Hypotheses 2009; 73:347-56. [PMID: 19410381 DOI: 10.1016/j.mehy.2008.09.059] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 09/09/2008] [Accepted: 09/12/2008] [Indexed: 11/17/2022]
Abstract
Obesity is associated with ever increasing social costs posing a general public health challenge. The most obvious reason for obesity, given healthy body functioning, is a positive calorie balance. This article delves into the lesser studied realm of the relationship of weight gain, in particular adipose tissue gain, with increased hydrogen ion concentration, taking protein and organic acids as important caveats in this discussion. The review opens the topic with the contradictory result of various studies reporting a positive relationship between chronic metabolic acidosis and weight loss. It goes to explain a process of weight gain, primarily adipose tissue gain, on acidogenic diets. Insufficient dietary protein could lead to muscle loss, and individual organic acids might indicate if there is any fatty acid oxidation or accumulation of hydrogen ion. The solution to the acid accumulation is discussed not in protein limitation but an increase in the consumption of vegetables and fruits. Finally, this review article based on studies published puts forward a physiological basis including a hypothesis to explain the possible link between hydrogen ion concentration and weight gain. This link could possibly explain the development of diseases and aging partially, and warrants research.
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Affiliation(s)
- Shoma Berkemeyer
- Ruhr-Universität-Bochum, Klinik für Altersmedizin und Frührehabilitation, Studienbüro, Room 23, Widumerstr. 8, 44627 Herne, Germany.
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23
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Abstract
Most very low birth weight preterm infants experience postnatal growth failure in the neonatal ICU. In an attempt to minimize this phenomenon, the nutritional support of these infants has tended to become more aggressive in recent years and has become a focus of much study. Despite this attention, many questions remain unresolved. This article examines several of these issues, including the controversies regarding optimal postnatal growth velocity, early aggressive nutritional support, and the transition to enteral nutrition in preterm infants.
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24
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Abstract
Birth and adaptation to extrauterine life involve major shifts in the protein and energy metabolism of the human newborn. These include a shift from a state of continuous supply of nutrients including amino acids from the mother to cyclic periodic oral intake, a change in the redox state of organs, thermogenesis, and a significant change in the mobilization and use of oxidative substrates. The development of safe, stable isotopic tracer methods has allowed the study of protein and amino acid metabolism not only in the healthy newborn but also in those born prematurely and of low birth weight. These studies have identified the unique and quantitative aspects of amino acid/protein metabolism in the neonate, thus contributing to rational nutritional care of these babies. The present review summarizes the contemporary data on some of the significant developments in essential and dispensable amino acids and their relationship to overall protein metabolism. Specifically, the recent data of kinetics of leucine, phenylalanine, glutamine, sulfur amino acid, and threonine and their relation to whole-body protein turnover are presented. Finally, the physiological rationale and the impact of nutrient (amino acids) interventions on the dynamics of protein metabolism are discussed.
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Affiliation(s)
- Satish C Kalhan
- Department of Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio 44195, USA.
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25
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Grover A, Khashu M, Mukherjee A, Kairamkonda V. Iatrogenic malnutrition in neonatal intensive care units: urgent need to modify practice. JPEN J Parenter Enteral Nutr 2008; 32:140-4. [PMID: 18407906 DOI: 10.1177/0148607108314373] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Extrauterine growth retardation is a major clinical problem in very-low-birth-weight infants. Parenteral nutrition (PN) serves to achieve rapid maximal nutrition in early postnatal life. There is a lack of uniformity with regard to neonatal PN practice. The objective of this study is to ascertain current practice regarding neonatal PN prescription in the early postnatal period in the United Kingdom. METHODS A study questionnaire was e-mailed to neonatal pharmacists serving level 3 and major level 2 units in the United Kingdom between October 2005 and March 2006. Static numerical information regarding glucose, amino acids, and lipid prescription during the first 10 days of life was collected and compared with current recommendations. RESULTS Fifty-two (81%) units responded to the questionnaire; 4 units were excluded for incomplete data. Twenty-six units (54%) initiated PN on day 1. Full PN was achieved by the median age of 6 days. Twelve units (25%) achieved full PN only by day 7 or later. Maximum median amino acids were 2.9 g/kg/d. Only 13 units (27%) prescribed >/=3 g/kg/d, and 2 prescribed more than 3.5 g/kg/d. Nineteen units (39%) initiated lipids on day 1. Eleven units (23%) delayed lipids until day 3, and 2 units delayed lipids until day 4. In comparison to the recommended intake of calories and amino acids, the current median prescription would result in a cumulative deficit over the first 10 days of 420 kcal/kg and 11.9 g/kg, respectively. CONCLUSIONS Our study suggests diverse practice with regard to neonatal PN prescription in the United Kingdom. Current neonatal PN practice entails a significant calorie and protein deficit during early postnatal life and warrants further review.
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Affiliation(s)
- Anuj Grover
- Neonatal Unit, Leicester Royal Infirmary, Leicester, UK
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26
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Jadhav P, Parimi PS, Kalhan SC. Parenteral amino acid and metabolic acidosis in premature infants. JPEN J Parenter Enteral Nutr 2007; 31:278-83. [PMID: 17595435 PMCID: PMC1905854 DOI: 10.1177/0148607107031004278] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Aggressive parenteral nutrition (PN) including amino acids is recommended for low-birth-weight infants to prevent energy and protein deficit. Their impact on acid-base homeostasis has not been examined. METHODS We investigated the impact of dose and duration of parenteral amino acids, with cysteine, on acid-base parameters in 122 low-birth-weight infants. Premature infants <or=32 weeks, <or=1850 g, and receiving parenteral amino acids at 1.5 g/kg/d for an extended period (>24 hours), or 3 g/kg/d for a short (5 hour), extended (24 hour), or prolonged (3-5 days) duration were included in the study. Data were obtained at age 0-3 days (n = 43) or, when clinically stable, age 3-5 days (n = 49). Data from 30 infants, matched for birth weight and gestational age, receiving PN during the first 5 days after birth were also obtained. Acidosis was defined as pH <7.25. RESULTS Acidosis was evident in all infants between 2 and 5 days after birth. Infants with large patent ductus arteriosus (PDA) exhibited significantly (p < .05) lower pH early, had higher blood urea nitrogen levels (26 +/- 9 vs 18 + 8 mg/dL; p < .05), and had greater weight loss ( approximately 17% of birth weight) when compared with infants without PDA. Gestational age, weight loss, and patent ductus arteriosus accounted for 65% of variance in acidosis. CONCLUSIONS Low-birth-weight infants develop metabolic acidosis between 2 and 5 days after birth, irrespective of dose and duration of parenteral amino acid administration. Careful management of parenteral fluids and comorbidities may lower the incidence of acidosis and promote protein accretion.
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Affiliation(s)
- Pushkaraj Jadhav
- Schwartz Center for Metabolism and Nutrition and Department of Pediatrics, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
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27
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te Braake FWJ, van den Akker CHP, Riedijk MA, van Goudoever JB. Parenteral amino acid and energy administration to premature infants in early life. Semin Fetal Neonatal Med 2007; 12:11-8. [PMID: 17142119 DOI: 10.1016/j.siny.2006.10.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
After birth, the nutritional supply through the umbilical cord ceases. Premature infants do not immediately tolerate full enteral feedings, yet they retain high nutritional needs for both growth and metabolic maintenance. Parenteral nutrition should therefore be initiated as quickly as possible after premature birth, thereby reducing the dependence on endogenous substrates. Intrauterine studies show very high amino acid uptake, clearly exceeding accretion rates. Studies covering the early neonatal period demonstrate that the initiation of high-dose amino acid administration directly after birth is safe and effective, even at low energy intakes. Future research should reveal whether usage could be improved through better amino acid solutions or by providing more energy via lipids from birth onwards as well.
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Affiliation(s)
- F W J te Braake
- Department of Paediatrics - Division of Neonatology, Erasmus MC - Sophia Children's Hospital, Sp-3432, PO Box 2060, 3000 CB Rotterdam, The Netherlands
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Maggio L, Cota F, Gallini F, Lauriola V, Zecca C, Romagnoli C. Effects of high versus standard early protein intake on growth of extremely low birth weight infants. J Pediatr Gastroenterol Nutr 2007; 44:124-9. [PMID: 17204965 DOI: 10.1097/01.mpg.0000237927.00105.f7] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Early provision of protein has been shown to limit catabolism and could improve growth. Our objective was to determine whether early aggressive protein intake improved growth outcomes of extremely low birth weight (ELBW) infants. PATIENTS AND METHODS ELBW infants were included in the study if they had no major congenital anomalies or renal failure and were still hospitalized at 36 weeks postmenstrual age. In 25 infants (HP) the early protein intake was planned to be 20% greater than in 31 historical controls (SP). RESULTS The 2 groups were similar in the baseline characteristics. The mean protein intake during the first 14 days of life was significantly greater in the HP group (3.1 +/- 0.2 vs 2.5 +/- 0.2 g/kg/d; P<0.0001). HP group showed lower postnatal weight loss (-3.1%; 95% confidence interval [CI] -5.9, -0.2) and earlier regain of birth weight (-4.1 days; 95% CI -6.6, -1.7). Mean blood urea nitrogen and bicarbonate levels were similar; mean serum glucose level was lower in the HP group (-21,7 mg/dL; 95% CI -41.9,-1.5). HP infants had a reduced fall in weight z score (-0.57; 95% CI -1.01, -0.12) and in length z score (-0.51; 95% CI -0.97, -0.05) from birth to discharge. CONCLUSION Early high protein intake was associated with improved weight and length growth outcomes at discharge. These findings highlight the benefits of aggressive protein intake immediately after birth.
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Affiliation(s)
- Luca Maggio
- Division of Neonatology, Department of Paediatrics, Catholic University of the Sacred Heart, Rome, Italy.
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Pieltain C, Habibi F, Rigo J. Apports nutritionnels précoces, hypotrophie acquise et devenir du prématuré. Arch Pediatr 2007; 14 Suppl 1:S11-5. [DOI: 10.1016/s0929-693x(07)80005-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kotsopoulos K, Benadiba-Torch A, Cuddy A, Shah PS. Safety and efficacy of early amino acids in preterm <28 weeks gestation: prospective observational comparison. J Perinatol 2006; 26:749-54. [PMID: 17024139 DOI: 10.1038/sj.jp.7211611] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of early amino acid (AA) administration in preterm neonates <28 weeks gestational age. STUDY DESIGN Prospective data collection for 1 year for the late AA group (AA started at 12-30 h) and for another year with practice change to early AA administration (immediately after stabilization). RESULTS Time of initiation of AA differed (early group 4+/-3 h vs late group 20+/-6 h; P<0.001). There were no statistically significant differences in the incidence of clinically significant metabolic acidosis. Blood urea at 24 h was higher in the early AA group. No significant differences in growth rate or neonatal outcomes were identified. Days to regain birth weight and sepsis were lower in the early AA group. CONCLUSIONS Early AA administration was not associated with any clinically significant adverse effects; it was associated with reduction in the incidence of sepsis and marginally effective in reducing time to regain birth weight.
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Affiliation(s)
- K Kotsopoulos
- Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Canada
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Cormack BE, Bloomfield FH. Audit of feeding practices in babies<1200 g or 30 weeks gestation during the first month of life. J Paediatr Child Health 2006; 42:458-63. [PMID: 16898885 DOI: 10.1111/j.1440-1754.2006.00897.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM In 2002, the composition of the breast milk fortifier used in our hospital changed, giving increased protein and energy. We therefore decided to prospectively audit nutritional management in our unit and to compare nutritional intake and growth in our babies with published data. METHODS Data were prospectively collected over a 3-month period on infants<1200 g or 30 weeks gestation. Prescribed and delivered volumes of all parenteral and enteral fluids were recorded. Babies were weighed as per unit protocol. RESULTS Thirty-four infants met the audit criteria. Data are median (range). After the first week of life, energy and protein intakes were 147 (78-174) kcal/kg/day and 3.9 (2.1-4.8) g/kg/day respectively. Daily weight gain was 17 (-3.2-35.4) g/kg and was significantly associated with both energy and protein intakes (P<0.001). However, standard deviation scores for weight fell from 0.15 (-1.9-2.0) at birth to -1.0 (-2.9-0.8) by 36 weeks corrected age. Time to commencing enteral feeds was 1 (1-3) day and to full enteral feeds was 8 (5-28) days. One infant was diagnosed with necrotising enterocolitis and eight with chronic lung disease. Mean protein intake was significantly lower in babies with chronic lung disease (P=0.005). CONCLUSION Overall, nutritional intakes and weight gain in this cohort of babies lie within the recommended ranges, although protein intakes in the smallest babies are at the lower end of the range. Enteral feeds are introduced early and advanced rapidly, but we have a low incidence of necrotising enterocolitis. However, babies still fell across weight centiles, suggesting that actual intakes for these tiny babies may be inadequate.
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Affiliation(s)
- Barbara E Cormack
- Newborn Services, National Women's Health, Auckland City Hospital, and Liggins Institute, University of Auckland, New Zealand.
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Abstract
Child health and development are contingent on sound nutrition during the neonatal period. The nutritional needs of all infants include adequate intake of fluid and energy; a balance among proteins, carbohydrates, and fats; and proper vitamin and mineral intake. Preterm infants have similar nutritional requirements but demand more frequent assessment of nutritional health and ongoing adjustment of nutritional intake throughout the neonatal period to ensure appropriate growth and development. Evidence-based nursing practice calls for an update on the specific nutritional requirements of infants, special nutritional needs of preterm infants, and the most recent changes in the composition of infant formula.
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Affiliation(s)
- Katherine Gregory
- W. F. Connell School of Nursing, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.
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Abstract
Significant advances have occurred during the past 20 years in the understanding of the complex relationships of the environment, the developing gut-associated immune system, the bacterial flora, the barrier functions of the gut, and the effects of nutrient intake. These advances have produced a profoundly different way of interpreting the nutritional requirements for normal growth and development of premature infants throughout their entire life.
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Affiliation(s)
- Heather Brumberg
- Regional Neonatal Center, Department of Pediatrics, Division of Newborn Medicine, Westchester Medical, New York Medical College, Valhalla, NY 10595, USA
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