Aggressive Early Total Parental Nutrition in Low-Birth-Weight Infants

Abstract

This study shows that aggressive intake of AA and IL can be tolerated immediately after birth by VLBW infants. Also, ETPN significantly increased positive nitrogen balance and caloric intake, without increasing the risk of metabolic acidosis, hypercholesterolemia, or hypertriglyceridemia.

Safety and efficacy of early amino acids in preterm <28 weeks gestation: prospective observational comparison

“…However, the number of patients studied is too small in both studies to detect significant difference in these outcomes. Other studies have reported 'early administration of AA'; 17,[21][22][23][24] however, the intervention group in those studies were similar to the late AA groups in these studies 12,13 and our study. Postnatal malnutrition has been increasingly implicated not only with postnatal growth but also with neurodevelopmental outcomes and certain adult-onset diseases including diabetes mellitus and hypertension.…”

“…7,25 -29 Previous concerns of metabolic acidosis and hyperammonemia 10,11 have been challenged in recent studies of improved AA formulations. 12,21,23,24 However, a word of caution is warranted as our study and the study by Te Braake et al 13 identified clinically unimportant but statistically significant differences in the values for pH, HCO 3 and base deficit indicative of metabolic acidosis. Overall, from a practical standpoint with the preparation of 'stock' solutions of 5, 7.5 and 10% dextrose and 2 g of AA/100 ml we are now able to initiate AA in the resuscitation room.…”

“…The elevated urea levels in the early AA group in our study are similar to previously reported, 13 and reflects higher protein turnover and elevated oxidation of AA rather than toxicity. 21 Ibrahim et al 12 in another randomized trial of 32 neonates administered AA at 3.5 g/kg/day within 2 h of birth and compared to AA started at 2 g/kg/day at 48 h of age. Early AA administration was well tolerated, resulted in positive nitrogen balance without significant impact on common outcomes of preterm infants.…”

“…10,11 However, with changes in the formulations and development of specific AA solutions, these concerns are being challenged. Randomized controlled studies 12,13 using AA solutions immediately after birth revealed that this practice is not associated with these complications.…”

“…12 The number of infants evaluated to date to assess the safety and effectiveness of early TPN administration in extreme preterm neonates is small. The objective of this study was to assess the safety and efficacy of early AA administration in preterm neonates <28 weeks GA in association with a practice change.…”