Effects of Two Different Doses of Amino Acid Supplementation on Growth and Blood Amino Acid Levels in Premature Neonates Admitted to the Neonatal Intensive Care Unit: A Randomized, Controlled Trial

Clark, Reese H.; Chace, Donald H.; Spitzer, Alan R.

doi:10.1542/peds.2007-0545

Cited by 148 publications

(141 citation statements)

References 26 publications

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“…On day 7, tyrosine levels were low in 47.5% of the neonates. 12 Increased supplementation did not influence thyroxine levels or how they changed over time (Table 1 and Figure 1). …”

Section: Resultsmentioning

confidence: 93%

“…On day 7, tyrosine levels were low in 47.5% of the neonates. 12 While these data are not definitive, the changes in thyroxine levels and tyrosine levels look similar (Figure 1). The low thyroxine levels may, in part, be due to tyrosine deficiency.…”

Section: Discussionmentioning

confidence: 90%

“…12 A secondary aim of our clinical trial was the evaluation of the influence of gestational age, time and the degree of amino-acid supplementation on thyroxine levels. We hypothesized that an increase of amino-acid supplementation would be associated with the normalization of serum amino acids and that this would improve thyroxine synthesis.…”

Section: Study Objectivesmentioning

confidence: 99%

“…The primary study did not demonstrate improved growth or reduced morbidity. 12 However, it was noted that changes in thyroxine levels did occur during the course of the trial. 12 A secondary objective was the evaluation of the influence of gestational age, time and the degree of amino-acid supplementation on thyroxine levels.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Defining congenital hypothyroidism is particularly complex in premature neonates because prematurely born infants often have a low free thyroxine value and a low or normal TSH value, termed as transient hypothyroxinemia of prematurity. Premature deliveries account for approximately 12.5% of all births in the United States and The National Center for Health Statistics estimates that over 500 000 babies are born prematurely each year. 3 Congenital hypothyroidism is estimated to occur in 1 in 4000 newborns and hypothyroidism that goes undetected results in poor growth and developmental delay.…”

Section: Introductionmentioning

confidence: 99%

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The influence of amino-acid supplementation, gestational age and time on thyroxine levels in premature neonates

Kelleher¹,

Clark²,

Steinbach³

et al. 2008

J Perinatol

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Objective: Newborn screening laboratories vary in the values that are used to define congenital hypothyroidism. Defining congenital hypothyroidism is particularly complex in premature neonates because prematurely born infants often have a low free thyroxine value and low or normal TSH value, termed as transient hypothyroxinemia of prematurity. In a multicenter (n ¼ 11 sites) trial, we randomly allocated premature neonates with a gestational age of 23 to 29 and 6/7 weeks to one of two parenteral nutrition approaches. The primary objective of our trial was to measure the effect of two distinct strategies of parenteral nutrition on neonatal growth and blood amino acids. A protocol defined secondary aim of our clinical trial was the evaluation of the influence of gestational age, time and the degree of amino-acid supplementation on total thyroxine levels. We hypothesized that an increase of amino-acid supplementation would be associated with the normalization of serum amino acids and that this would improve thyroxine synthesis.Study Design: Premature neonates (23 to 29 and 6/7 weeks) were randomly allocated to one of two approaches to intravenous amino-acid administration. In one group, amino-acid supplementation started at 1.0 g kg À1 per day and advanced by 0.5 g kg À1 per day to a maximum of 2.5 g kg À1 per day (2.5 group). The other group received amino acids at 1.5 g kg À1 per day and advanced by 1.0 g kg À1 per day to a maximum of 3.5 g kg À1 per day (3.5 group). Filter paper blood spots were obtained on the day of randomization, and on days 7 and 28 of age to monitor laboratory values.Result: Enrollment included 122 neonates, 64 in the 3.5 group and 58 in the 2.5 group. There were no differences in demographics or baseline characteristics between the two treatment groups. There were no significant differences in thyroid levels at baseline, on days 7 and 28 between the two treatment groups. Growth was similar in both groups. It was noted that thyroxine levels changed over time and that the changes with time were greatest in the most preterm neonates. Conclusion:The degree of amino-acid supplementation does not influence thyroxine levels and both time from birth and gestational age do influence thyroxine levels.

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“…On day 7, tyrosine levels were low in 47.5% of the neonates. 12 Increased supplementation did not influence thyroxine levels or how they changed over time (Table 1 and Figure 1). …”

Section: Resultsmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 90%

Section: Study Objectivesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The influence of amino-acid supplementation, gestational age and time on thyroxine levels in premature neonates

Kelleher¹,

Clark²,

Steinbach³

et al. 2008

J Perinatol

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Higher versus lower protein intake in formula-fed low birth weight infants

Premji

Fenton

Sauvé

2006

Cochrane Database of Systematic Reviews

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This systematic review suggests that higher protein intake (=> 3.0 g/kg/day but < 4.0 g/kg/day) from formula accelerates weight gain. Based on increased nitrogen accretion rates, this most likely indicates an increase in lean body mass. Although accelerated weight gain is considered to be a positive effect, increase in other outcome measures examined may represent a negative or ambivalent effect. These include elevated blood urea nitrogen levels and increased metabolic acidosis. Limited information was available regarding the impact of higher formula protein intakes on long term outcomes such as neurodevelopmental abnormalities. As determined in this review, existing research literature on this topic is not adequate to make specific recommendations regarding the provision of very high protein intake (> 4.0 g/kg/day) from formula.

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Higher versus lower protein intake in formula-fed low birth weight infants

Fenton

Premji

Al-Wassia

et al. 2014

Cochrane Database of Systematic Reviews

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Higher protein intake (≥ 3.0 g/kg/d but < 4.0 g/kg/d) from formula accelerates weight gain. However, limited information is available regarding the impact of higher formula protein intake on long-term outcomes such as neurodevelopmental abnormalities. Available evidence is not adequate to permit specific recommendations regarding the provision of very high protein intake (> 4.0 g/kg/d) from formula during the initial hospital stay or after discharge.

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Effects of Two Different Doses of Amino Acid Supplementation on Growth and Blood Amino Acid Levels in Premature Neonates Admitted to the Neonatal Intensive Care Unit: A Randomized, Controlled Trial

Abstract: Higher doses of amino acid supplementation did not improve neonatal growth and were associated with increased blood amino acid and urea nitrogen levels.

Cited by 148 publications

References 26 publications

The influence of amino-acid supplementation, gestational age and time on thyroxine levels in premature neonates

The influence of amino-acid supplementation, gestational age and time on thyroxine levels in premature neonates

Higher versus lower protein intake in formula-fed low birth weight infants

Higher versus lower protein intake in formula-fed low birth weight infants

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