Elsevier

The Journal of Pediatrics

Volume 163, Issue 3, September 2013, Pages 638-644.e5
The Journal of Pediatrics

Original Article
Safety and Efficacy of Early Parenteral Lipid and High-Dose Amino Acid Administration to Very Low Birth Weight Infants

https://doi.org/10.1016/j.jpeds.2013.03.059Get rights and content

Objective

To assess the efficacy and safety of early parenteral lipid and high-dose amino acid (AA) administration from birth onwards in very low birth weight (VLBW, birth weight <1500 g) infants.

Study design

VLBW infants (n = 144; birth weight 862 ± 218 g; gestational age 27.4 ± 2.2 weeks) were randomized to receive 2.4 g of AA kg−1·d−1 (control group), or 2.4 g AA kg−1·d−1 plus 2-3 g lipids kg−1·d−1 (AA + lipid group), or 3.6 g AA kg−1·d−1 plus 2-3 g lipids kg−1·d−1 (high AA + lipid group) from birth onwards. The primary outcome was nitrogen balance. The secondary outcomes were biochemical variables, urea rate of appearance, growth rates, and clinical outcome.

Results

The nitrogen balance on day 2 was significantly greater in both intervention groups compared with the control group. Greater amounts of AA administration did not further improve nitrogen balance compared with standard AA dose plus lipids and was associated with high plasma urea concentrations and high rates of urea appearance. No differences in other biochemical variables, growth, or clinical outcomes were observed.

Conclusions

In VLBW infants, the administration of parenteral AA combined with lipids from birth onwards improved conditions for anabolism and growth, as shown by improved nitrogen balance. Greater levels of AA administration did not further improve the nitrogen balance but led to increased AA oxidation. Early lipid initiation and high-dose AA were well tolerated.

Section snippets

Methods

Between December 2008 and January 2012, we performed a randomized controlled trial at the NICU of the Erasmus MC–Sophia Children’s Hospital in Rotterdam, The Netherlands. The eligible patients were inborn VLBW infants (birth weight <1500 g) with a central venous catheter in place to allow for more concentrated glucose solutions and to restrict total fluid intake. Written informed consent was obtained from the infants’ parents before they were included. Exclusion criteria were congenital

Results

We included 144 VLBW infants: 48 in the control group, 49 in the AA + lipid group, and 47 in the high AA + lipid group (Figure 1; available at www.jpeds.com). Baseline characteristics are in Table I. Parenteral AA and lipid intake (Figure 2; available at www.jpeds.com) and total parenteral + enteral protein and energy intake (Table II; available at www.jpeds.com) were in agreement with the study protocol. Compared with the targeted intake of 3.6 g AA/day, the cumulative parenteral AA deficit on

Discussion

We demonstrated that 2-3 g of lipids kg−1·d−1 from birth onwards improved the nitrogen balance in VLBW infants compared with the initiation of lipids from the second day onwards, and a 50% greater AA intake (3.6 g·kg−1·d−1 vs 2.4 g·kg−1·d−1) did not further improve anabolism. The results of this study should be interpreted in the light of adjustments made to the parenteral nutritional intake. A total of 40%-80% of the infants required individual adjustments based on the urea and TG thresholds

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    The authors declare no conflicts of interest.

    Registered with TrialRegister.nl: NTR1445.

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