Adaptive regulation of amino acid metabolism on early parenteral lipid and high-dose amino acid administration in VLBW infants – A randomized, controlled trial

Nutritional Evaluation and Optimisation in Neonates (NEON) trial of amino acid regimen and intravenous lipid composition in preterm parenteral nutrition: a randomised double-blind controlled trial

“…40,41 We found a significantly higher incidence of elevated blood urea concentrations in the groups receiving the DISCUSSION NIHR Journals Library www.journalslibrary.nihr.ac.uk RDI of amino acids. This is also in keeping with the studies of Vlaardingerbroek et al, 35,67 although there was no associated increased incidence of metabolic acidosis. The significance of elevated blood urea in the early postnatal period in preterm infants is unclear.…”

Albumin synthesis in very low birth weight infants is enhanced by early parenteral lipid and high-dose amino acid administration

“…Plasma [U-13 C 6 ]a-ketoisocaproic acid ([U-13 C 6 ]a-KIC) enrichments were measured at steady state using a gas chromatograph mass spectrometer (GC/MS: MSD 5975C; Agilent, Amstelveen, The Netherlands) and used as precursors for albumin synthesis [14,17,18]. Plasma albumin concentrations were routinely measured on a Roche Hitachi 912 (Roche Diagnostics, Basel, Switzerland).…”

“…After hydrolyzation with HCl, leucine was isolated and derivatized using ethyl chloroformate (ECF) [14]. Enrichments of leucine were then measured on a gas chromatograph combustion isotope ratio mass spectrometer (GC/C/IRMS; Delta XP; Thermo Electron, Bremen, Germany) as previously described [7,10].…”

“…The included infants were a subset of the infants included in a study by Vlaardingerbroek et al [12,13] determining the safety and efficacy of early lipid (soybean oil or a multicomponent emulsion) initiation with or without additional amino acids from birth onwards. In addition, the metabolism of the amino acids leucine and phenylalanine in this subset of infants was published previously [14]. Excluded were infants with congenital anomalies, including chromosome defects; infants with metabolic diseases; and those with endocrine, renal or hepatic disorders.…”

Nutrición parenteral en situaciones clínicas especiales

“…Así, en el RN prematuro < 1.500 g el aporte proteico inicial de 2,4 g/kg/día junto a lípidos (2 g/kg/día el primer día, incrementando a 3 g/kg/día el segundo) mejoró el balance nitrogenado respecto al mismo aporte proteico sin lípidos (7). Aportes iniciales superiores (3,6 g/kg/día junto a lípidos) no han demostrado mejorar el balance nitrogenado y se asocian a aumento de urea plasmática que refleja una mayor oxidación de AA (7,9). En un reciente ensayo clínico con RN prematuros < 1.500 g se demostró mayor síntesis de albúmina en 12 pacientes con aporte precoz proteico de 3,6 g/ kg/día junto a lípidos comparados con 9 pacientes que recibieron 2,4 g/kg/día junto a lípidos (8), datos que deben ser refrendados en estudios de mayor tamaño muestral (ver capítulo de "Requerimientos en nutrición parenteral pediátrica" para incrementos posteriores).…”