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

Kotsopoulos, Kirsten; Benadiba-Torch, A; Cuddy, Angela Elizabeth; Shah, Prakesh S.

doi:10.1038/sj.jp.7211611

Cited by 45 publications

(31 citation statements)

References 29 publications

(39 reference statements)

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“…5,[7][8][9] Other investigations have also described an association between cholestasis and the quantity and formulation of amino acids administered parenterally, excess caloric intake of fats and carbohydrates, 10,11 toxicity of trace minerals, [12][13][14][15][16] male gender, 17 perinatal asphyxia, 18 phototoxicity of multivitamin 2 Aggressive administration of parenteral amino acids to improve protein accretion rates in very preterm neonates has been supported in the literature. [24][25][26][27] Although tolerance of high-dose amino acids has been described, researchers acknowledge that sensitive tests to monitor amino-acid toxicity are not readily available in the clinical setting. 25,28 Our study results are consistent with previous reports that associate cholestasis with increased duration of parenteral nutrition and higher cumulative dose of amino acids.…”

Section: Discussionmentioning

confidence: 99%

Demographic and nutritional factors associated with prolonged cholestatic jaundice in the premature infant

et al. 2007

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Objective: The primary aim of this study was to determine if an association exists between amino-acid levels and development of cholestasis. The secondary aim of our amino-acid dose comparison trial was to identify factors associated with the development of prolonged cholestatic jaundice.Study Design: We compared demographic characteristics and amino-acid levels in neonates who developed cholestasis with those who did not. Parenteral-associated cholestatic liver disease was defined as a direct serum bilirubin above 5 mg per 100 ml any time during the first 28 days after birth in neonates with no history of biliary atresia or viral hepatitis. We obtained filter paper blood spots for amino acid and acylcarnitine measurements on the day of randomization and days 7 and 28 of age to identify a profile of values that could be used to identify neonates with evidence of abnormal liver function. Result:We enrolled 122 neonates in our study; 13 (10.7%) developed cholestasis. Neonates who developed cholestasis were more immature, had lower birth weight, were exposed to parenteral nutrition for a longer period, had a higher cumulative dose of amino acids, were less often on enteral nutrition by day 7 of age, more often had a patent ductus arteriosus and severe intraventricular hemorrhage and were more commonly treated with steroids by 28 days of age. Amino acid and acylcarnitine values were not different for the two groups on the day of randomization. On day 7 (parenteral phase of nutrition), blood urea nitrogen, citrulline, histidine, methionine and succinyl carnitine were higher, and serine, glutamate and thyroxine levels were lower in the neonates who developed cholestasis than in who did not. Conclusion:Cholestasis remains an important complication of parenteral nutrition, and several clinical and biochemical factors may be helpful in identifying high-risk patients.

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Section: Discussionmentioning

confidence: 99%

Demographic and nutritional factors associated with prolonged cholestatic jaundice in the premature infant

et al. 2007

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“…1,2 Postnatal growth restriction can occur because of inadequate nutritional intake, increased energy demands with concomitant protein deficits and administration of drugs (diuretics and steroids). [3][4][5][6] Malnutrition at a vulnerable period of brain development adversely influences long-term developmental outcomes through decreased numbers of brain cells. [7][8][9] Malnutrition directly affects the child's energy level, rate of motor development and rate of growth, thus interfering with neurodevelopment.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of early parenteral nutrition for premature infants

2009

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Objective: The objective of this study was to evaluate the safety and efficacy of early amino acid (early AA) administration in very low birth weight (VLBW) infants.Study Design: A pre-and post-intervention study was conducted after initiating an early AA administration protocol. Clinical outcomes were collected for all VLBW infants admitted on the first day of life for 9 months before protocol initiation (standard parenteral nutrition (PN)), and 10 months after initiation of early AA.Result: In all, 88 infants met study criteria for standard PN, and 85 infants for early AA administration. The patient characteristics were similar between the groups. There were no differences in mortality, the day birth weight was regained, the day enteral feeds started, the duration of PN, the day full feeds achieved and weight at 32 weeks post-menstrual age. No differences were found for late sepsis, direct hyperbilirubinemia and chronic lung disease. Necrotizing enterocolitis (NEC) occurred more frequently in the early AA administration group (12 vs 1%, P ¼ 0.012).

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“…They found no clinically significant associations between protein intake and degree of acidosis or BUN. 23 Ridout et al retrospectively evaluated 121 neonates with birth weight <1250 g who received exclusive parenteral nutrition in the first 3 days of life providing amino-acid intakes up to 3.7 g/kg/day. They found no association between BUN and protein intake in their study.…”

Section: Discussionmentioning

confidence: 99%

Blood urea nitrogen and serum bicarbonate in extremely low birth weight infants receiving higher protein intake in the first week after birth

et al. 2011

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

Cited by 45 publications

References 29 publications

Demographic and nutritional factors associated with prolonged cholestatic jaundice in the premature infant

Demographic and nutritional factors associated with prolonged cholestatic jaundice in the premature infant

Outcomes of early parenteral nutrition for premature infants

Blood urea nitrogen and serum bicarbonate in extremely low birth weight infants receiving higher protein intake in the first week after birth

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