Early optimal parenteral nutrition and metabolic acidosis in very preterm infants

Abstract

BackgroundIt is currently recognized that an optimized nutritional approach, consisting of an early and substantial supply of protein and energy by parenteral route, may be beneficial for very low birth weight infants and recent guidelines endorse this strategy. However, the impact of enhanced parenteral nutrition (PN) on acid-basic balance has never been investigated. The aim of the present study is to assess the effect of nutrient intake on acid-base homeostasis in a large population of preterm infants on PN.MethodsThis observational study described the acid-base profile of very preterm infants (≤29 week’s gestation) receiving PN during the first week of life. For this purpose three different cohorts of infants who received increasing (group 1 to group 3) nutritional intakes were considered. Nutrition data were recorded daily and correlated to acid-base data (pH, base excess, and lactate). The outcome measure to assess metabolic acidosis was the base excess (BE).Results161 infants were included. 1127 daily nutritional records and 795 blood gas data were analyzed. The three groups were different with regard to nutritional intravenous intakes. Group 3 in particular had a higher mean intake of both amino acids (3.3 ± 0.8 g/kg/d) and lipids (2.8 ± 1.4 g/kg/d) during the first week of life. Metabolic acidosis was more severe in the group with the highest parenteral intake of amino acids and lipids: mean BE = -8.7 ± 3.4 (group 3); -6.4 ± 3.4 (group 2); -5.1 ± 3.0 (group 1)]. At the multivariate analysis the significant risk factors for metabolic acidosis were: gestational age, initial base excess, amino acid and lipid intravenous intakes.DiscussionAcid-base homeostasis was influenced by the nutritional intake. Earlier and higher intravenous amino acid and lipid intakes particularly increased the risk of metabolic acidosis. The nutritional tolerance was different depending on gestational age, and the smaller infants (24–26 week’s gestation) displayed greater acidotic disequilibrium and a higher need of bicarbonate.

Sex Affects Human Premature Neonates’ Blood Metabolome According to Gestational Age, Parenteral Nutrition, and Caffeine Treatment

“…PN administration can lead to serious complications, being inappropriate or unsuitable for infants’ metabolic demand [ 34 , 35 , 36 ], so that a balance between the demand and intake of nutrients appears critical. As an example, earlier and higher intravenous amino acid and lipid intakes particularly increased the risk of metabolic acidosis in VPI, depending also on GA [ 37 ]. The results of our study indicate that sex is another variable that must be considered, highlighting the need to evaluate PN according to GA and sex.…”

Long-term effects on growth of an energy-enhanced parenteral nutrition in preterm newborn: A quasi-experimental study

“…Previous studies in similar setting do not report R-squared values [ 21 , 26 – 29 ]. Bonsante et al reported R-squared value of their linear regression analysis [ 7 ]. They only studied the influence of confounding variables on metabolic acidosis but not on growth parameters.…”

“…If a low caloric intake may impair growth, an energy overload may increase the risk of side effects associated with PN (i.e. hyperglycemia, hypertriglyceridemia, metabolic acidosis), particularly dangerous for critically ill individuals [1,6,7].…”

Mid-late pregnancy maternal glycolipids in gestational diabetes mellitus (GDM) fluctuated in glycosylated hemoglobin levels of 5.5%-6.4% associated with umbilical cord blood of amino acid and carnitine profiles: a nested case-cohort observational study

“…Foetal metabolism, as indicated by carnitine levels and amino acids, is related to the risk of preterm infants, maternal gestational age and neonatal development [23,24] . Dysglycaemia is an important link between maternal serum amino acids and carnitines [25] , maternal obesity/overweight [26] and maternal and foetal lipid pro les [27] .…”