Randomised trial of early diet in preterm babies and later intelligence quotient Postnatal Head Growth in Preterm Infants: A Randomized Controlled Parenteral Nutrition Study Parenteral amino acid intakes: possible influences of higher intakes on growth and bone status in preterm infants Safety and efficacy of early parenteral lipid and high-dose amino acid administration to very low birth weight infants. High Protein Intake Does Not Prevent Low Plasma Levels of Conditionally Essential Amino Acids in Very Preterm Infants Receiving Parenteral Nutrition Improving head growth in very preterm infants – a randomised controlled trial I: neonatal outcomes Impact of Early and High Amino Acid Supplementation on ELBW Infants at 2 Years Early provision of parenteral amino acids in extremely low birth weight infants: relation to growth and neurodevelopmental outcome. Effects of aggressive parenteral nutrition on growth and clinical outcome in preterm infants. The effect of cumulative energy and protein deficiency on anthropometric parameters in a pediatric ICU population. One Extra Gram of Protein to Preterm Infants From Birth to 1800 g: A Single-Blinded Randomized Clinical Trial Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Amino acid administration to premature infants directly after birth. 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 Early changes in plasma amino acid concentrations during aggressive nutritional therapy in extremely low birth weight infants. Targeting 2.5 versus 4 g/kg/day of amino acids for extremely low birth weight infants: a randomized clinical trial. The Effects of Early Parenteral Amino Acids on Sick Premature Infants Effect of Low versus High Intravenous Amino Acid Intake on Very Low Birth Weight Infants in the Early Neonatal Period
abstract Objectives : To determine whether perinatal nutrition influences cognitive function at 7 1/2 - 8 years in children born preterm . Design : R and omised , blinded nutritional intervention trial . Blinded follow up at 7 1/2 - 8 years . Setting : Intervention phase in two neonatal units ; follow up in a clinic or school setting . Subjects : 424 preterm infants who weighed under 1850 g at birth ; 360 of those who survived were tested at 7 1/2 - 8 years . Interventions : St and ard infant formula versus nutrient enriched preterm formula r and omly assigned as sole diet ( trial A ) or supplements to maternal milk ( trial B ) fed for a mean of 1 month . Main outcome measures : Intelligence quotient ( IQ ) at 7 1/2 - 8 years with abbreviated Weschler intelligence scale for children ( revised ) . Results : There was a major sex difference in the impact of diet . At 7 1/2 - 8 years boys previously fed st and ard versus preterm formula as sole diet had a 12.2 point disadvantage ( 95 % confidence interval 3.7 to 20.6 ; P<0.01 ) in verbal IQ . In those with highest intakes of trial diets corresponding figures were 9.5 point disadvantage and 14.4 point disadvantage in overall IQ ( 1.2 to 17.7 ; P<0.05 ) and verbal IQ ( 5.7 to 23.2 ; P<0.01 ) . Consequently , more infants fed term formula had low verbal IQ ( < 85 ) : 31 % versus 14 % for both sexes ( P=0.02 ) and 47 % versus 13 % in boys P=0.009 ) . There was a higher incidence of cerebral palsy in those fed term formula ; exclusion of such children did not alter the findings . Conclusions : Preterm infants are vulnerable to suboptimal early nutrition in terms of their cognitive performance — notably , language based skills — at 7 1/2 - 8 years , when cognitive scores are highly predictive of adult ones . Our data on cerebral palsy generate a new hypothesis that suboptimal nutritional management during a critical or plastic early period of rapid brain growth could impair functional compensation in those sustaining an earlier brain insult . Cognitive function , notably in males , may be permanently impaired by suboptimal neonatal nutrition BACKGROUND : Early postnatal head growth failure is well recognized in very preterm infants ( VPIs ) . This coincides with the characteristic nutritional deficits that occur in these  parenteral nutrition ( PN ) dependent infants in the first month of life .  Head circumference ( HC ) is correlated with brain volume and later neurodevelopmental outcome . We hypothesized that a St and ardized , Concentrated With Added Macronutrients Parenteral ( SCAMP ) nutrition regimen would improve early head growth . The aim was to compare the change in HC ( ΔHC ) and HC SD score ( ΔSDS ) achieved at day 28 in VPIs r and omly assigned to receive SCAMP nutrition or a control st and ardized , concentrated PN regimen . METHODS : Control PN ( 10 % glucose , 2.8 g/kg per day protein/lipid ) was started within 6 hours of birth . VPIs ( birth weight < 1200 g ; gestation < 29 weeks ) were r and omly assigned to either start SCAMP ( 12 % glucose , 3.8 g/kg per day protein/lipid ) or remain on the control regimen  . HC was measured weekly . Actual daily nutritional intake data were collected for days 1 to 28 . RESULTS : There were no differences in demographic data between SCAMP ( n = 74 ) and control ( n = 76 ) groups . Comparing cumulative 28-day intakes , the SCAMP group received 11 % more protein and 7 % more energy . The SCAMP group had a greater ΔHC at 28 days ( P < .001 ) . The difference between the means ( 95 % confidence interval ) for ΔHC was 5 mm ( 2 to 8) , and ΔSDS was 0.37 ( 0.17 to 0.58 ) . HC differences are still apparent at 36 weeks ’ corrected gestational age . CONCLUSIONS : Early postnatal head growth failure  in VPIs can be ameliorated by optimizing PN Objective : To study the possible influences of amino acid ( AA ) intakes on growth and bone status in preterms . Study Design : Newborns , weighing < 1250 g , received st and ard ( S ) or higher ( H ) parenteral AA intakes ( 3 or 4 g kg−1 per day ) . Anthropometry , biochemistry and quantitative ultrasound ( metacarpus bone transmission time ( mcBTT ) , in μs ) were measured prospect ively . Result : A total of 55 patients in group S and 60 in group H were studied . Significantly better growth rate was found in the H group during the study without signs of intolerance . We found a significant decrease in mcBTT from birth to 21 days in the H group ; nonetheless , mcBTT at 36 weeks of gestational age significantly positively correlated with early AA and energy intakes . A significant positive correlation between mcBTT and lower limb length ( LLL ) at 21 days was found . Conclusion : Early higher AA intakes  improved growth without short-term AA intolerance . Nutritional parameters could influence bone growth . LLL was the anthropometric parameter that best correlated to bone status 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 r and omized 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 st and ard 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 Background : We have shown that increasing protein intake using a st and ardized , concentrated , added macronutrients parenteral ( SCAMP ) nutrition regimen improves head growth in very preterm infants ( VPIs ) compared with a control parenteral nutrition ( PN ) regimen .  VPIs are at risk of conditionally essential amino acid ( CEAA ) deficiencies because of current neonatal PN amino acid ( AA ) formulations . We hypothesized that the SCAMP regimen would prevent low plasma levels of CEAAs . Aim : To compare the plasma AA profiles at approximately day 9 of life in VPIs receiving SCAMP vs a control PN regimen . Methods : VPIs ( < 29 weeks ’ gestation ) were r and omized to receive SCAMP ( 30 % more PN AA ) or a control regimen .  Data were collected to measure parenteral and enteral protein , energy , and individual AA intake and the first plasma AA profile . Plasma profiles of the 20 individual protogenic AA levels were measured using ion exchange chromatography . Results : Plasma AA profiles were obtained at median ( interquartile range [ IQR ] ) age of 9 ( 8–10 ) days in both SCAMP ( n = 59 ) and control ( n = 67 ) groups after r and omizing 150 VPIs . Median ( IQR ) plasma levels of individual essential AAs were higher than the reference population mean ( RPM ) in both groups , especially for threonine . SCAMP infants had higher plasma levels of essential AAs than did the controls . Median ( IQR ) plasma levels of glutamine , arginine , and cysteine ( CEAAs ) were lower than the RPM in both groups . Conclusion : Plasma AA levels in PN-dependent VPIs indicate there is an imbalance in essential and CEAA provision in neonatal PN AA formulations that is not improved by increasing protein intake Background : Infants born very preterm are at an increased risk of poor growth in the post-natal period . Poor brain growth in this critical period may result from inadequate nutrition , and has long-term effects on neurodevelopmental outcome . Aims : To examine the feasibility of providing macronutrients at amounts above current recommendations ( hyperalimentation ) to improve nutrition and head growth in preterm infants . Methods : 142 infants < 29 weeks ' gestation were r and omised to hyperalimented or st and ard parenteral and enteral nutrition .  Growth was monitored from birth to 36 weeks ' postmenstrual age ( PMA ) . The primary outcome measure was occipitofrontal circumference ( OFC ) at 36 weeks ' PMA . Results : 55 infants in the intervention group and 59 infants in the control group survived to 36 weeks ' PMA . 11 ( 16 % ) infants in the intervention group and 13 ( 18 % ) infants in the control group were small for gestational age ( SGA ) . There was no statistically significant difference between the two groups in the primary outcome measure or other growth variables . Babies in the intervention group received significantly more energy and protein , but 80 % were still in a cumulative protein/energy deficit at the end of 4 weeks . 20 ( 24 % , p = 0.008 ) of those in deficit at 4 weeks had an OFC of more than 2 SD below the mean at 36 weeks ' PMA , as opposed to none of those not in deficit . Conclusion : Cumulative energy/protein deficit is predictive of poor head growth , but the delivery of adequate intakes remains a challenge in the preterm Objective : The aim of the present study was to examine the effects of early and high intravenous ( IV ) amino acid ( AA ) supplementation on growth , health , and neurodevelopment of extremely-low-birth-weight ( ELBW ) infants throughout their first 2 years of life . Methods : Infants were prospect ively r and omized in a double-masked fashion and treated for 7 days with either IV AA starting at 0.5 g · kg−1 · day−1 and increased by 0.5 g · kg−1 every day to 3 g · kg−1 · day−1 or starting at 2 g · kg−1 · day−1 of IV AA and advanced by 1 g · kg−1 every day to 4 g · kg−1 · day−1 . Plasma AA concentrations were determined by reverse-phase high-performance liquid chromatography . Survivors were longitudinally assessed with Bayley II Scales of Infant Development and physical , social , and global health . Results : Forty-three of 51 survivors were studied . Mental Developmental Index ( MDI ) and Psychomotor Developmental Index were similar between groups ; however , the early and high AA group had a lower MDI at 18 months . This difference disappeared at 2 years of age . The early and high AA group z score means for weight , length , and head circumferences were significantly lower than the st and ard AA group at most visits . Cumulative and single plasma AA concentrations correlated negatively with MDI and postnatal growth . Conclusions : ELBW infants who received early and high IV AA during the first week of life were associated with poor overall growth at 2 years OBJECTIVE To determine if postnatal growth failure exerts an adverse effect on subsequent growth and neurodevelopment . STUDY DESIGN A secondary analysis of 1018 infants who were enrolled in a r and omized , clinical trial of glutamine supplementation  was performed to determine whether early provision of parenteral amino acids ( AA ) is associated with better growth and neurodevelopmental outcomes . Infants were stratified by whether they were provided > or =3 g/kg per day of AA at < or = 5 days of life ( early ; n = 182 ) or not ( late ; n = 836 ) . RESULTS At 36 weeks ' postmenstrual age , significant differences were found in weight , length , and head circumference in favor of the infants who received early AA ; the odds of having weight less than the 10(th ) percentile for age was 4-fold higher for infants in the late group . At 18 months ' CA , there were no differences in weight , length , or measures of neurodevelopment between the groups ; however , male infants in the late group were twice as likely to have head circumference less than the 10(th ) percentile . CONCLUSIONS Early AA were associated with significantly better growth outcomes at 36 weeks ' postmenstrual age , and fewer infants who received early AA were found to have suboptimal head growth at 18 months ' CA BACKGROUND The goal of nutrition in the preterm infant is to achieve postnatal growth approximating normal fetal growth . During the early postnatal period , protein intake must be sufficient to achieve normal postnatal growth in extremely low-birthweight infants . The aim of this study was to test the hypothesis that giving higher amounts of amino acids and lipids to infants born at < 34 gestational weeks ( GW ) may improve growth at the 40th week of gestation and have a positive preventive effect on development of retinopathy of prematurity ( ROP ) . METHODS Fifty-three neonates born at < 34 GW and hospitalized in the neonatal intensive care unit ( NICU ) were included in this prospect i ve study . They were r and omly divided into two groups . Group 1 received aggressive parenteral nutrition ( PN ) ( amino acids 3 g/kg per day and lipids 2 g/kg per day on first day of life ) . Group 2 received conventional PN ( amino acids 1.5 g/kg per day and lipids 1 g/kg per day on first day of life ) . The anthropometric measurements , clinical outcomes and serum levels of insulin-like growth factor-I ( IGF-I ) , IGF binding protein ( IGFBP ) and thyroid hormones were compared between groups . RESULTS At 40 weeks of gestation , height , head circumference and serum IGF-I and IGFBP3 were statistically higher in the group receiving aggressive PN .  Thyroid hormones were not affected by aggressive PN . The lower levels of IGF-I and IGFBP3 in the group receiving conventional PN were negatively correlated with development of ROP . CONCLUSION Aggressive PN seems to positively affect neonates '  anthropometric measurements at the 40th gestational week and the development of ROP . These effects may be related to high levels of IGF-I and IGFBP3 BACKGROUND AND AIMS Nutritional support is essential in the care of critically ill children since inadequate feeding increases morbidity and negatively affects growth . We aim ed to compare cumulative energy and protein intakes with recommended dietary intakes ( RDA ) and examine relationships between accumulated balances and anthropometric parameters . METHODS Prospect i ve , observational study . Total daily energy and protein intakes were determined during a maximum of 14 days in 261 children admitted to our multidisciplinary tertiary pediatric ICU . Actual intakes were subtracted from RDA and cumulative balances were calculated . Relations between cumulative balances , various clinical factors and changes in anthropometry ( weight , arm and calf circumference ) were analyzed using regression analysis . RESULTS At 14 days after admission children showed significant cumulative nutritional deficits compared to RDA . These deficits were on average 27 , 20 , 12 kcal/kg and 0.6 , 0.3 , and 0.2 g protein/kg per day for preterm neonates ( n = 103 ) , term neonates ( n = 91 ) and older children ( n = 67 ) , respectively . Age at admission , length of ICU-stay and days on mechanical ventilation were negatively related to cumulative balances . Cumulative energy and protein deficits were associated with declines in SD-scores for weight and arm circumference . CONCLUSIONS Children admitted to the ICU accumulate substantial energy and protein deficits when compared to RDA . These deficits are related to decreases in anthropometric parameters Objective : The aim of the study was to evaluate the effect on growth and neurodevelopment of increasing amino acid ( AA ) during parenteral nutrition and protein intake during enteral nutrition in extremely low birth-weight infants starting from birth to day of reaching 1800 g body weight . Methods : We r and omized preterm infants with birth weight 500 to 1249 g either to a  high AA/protein intake ( HiP [ high protein ] : parenteral nutrition = 3.5 AA , enteral nutrition = 4.6 protein g · kg−1 · day−1 ) or to a st and ard of care group ( StP [ st and ard protein ] : parenteral nutrition = 2.5 AA , enteral nutrition = 3.6 protein g · kg−1 · day−1 ) . The primary outcome was weight gain from birth to 1800 g. Results : Two : hundred twenty-six patients were screened , 164 completed the study and were analyzed ( 82 StP and 82 HiP ) . Cumulative AA/protein intake from birth to 1800 g was 178 ± 42 versus 223 ± 45 g/kg in the StP versus HiP group respectively , P < 0.0001 . Blood urea was higher in HiP than in StP group both during parenteral and enteral nutrition ( P = 0.004 ) . Weight gain from birth to 1800 g was 12.3 ± 1.6 in StP and 12.6 ± 1.7 g · kg−1 · day−1 in HiP group ( P = 0.294 ) . We found no difference in any growth parameters neither during hospital stay nor at 2 years corrected age . Bayley III score at 24 months corrected age was 93.8 ± 12.9 in StP group and 94.0 ± 13.9 in the HiP group , P = 0.92 . Conclusions : Increasing AA/protein intake both during parenteral and enteral nutrition does not improve growth and neurodevelopment of small preterm infants 500 to 1249 g birth weight AIMS To improve energy intake in sick very low birthweight ( VLBW ) infants ; to decrease growth problems , lessen pulmonary morbidity , shorten hospital stay , and avoid possible feeding related morbidity . Morbidity in VLBW infants thought to be associated with parenteral and enteral feeding includes bronchopulmonary dysplasia , necrotising enterocolitis , septicaemia , cholestasis and osteopenia of prematurity . METHODS A prospect i ve r and omised controlled trial ( RCT ) comparing two types of nutritional intervention was performed involving 125 sick VLBW infants in the setting of a regional neonatal intensive care unit . Babies were r and omly allocated to either an aggressive nutritional regimen ( group A ) or a control group ( group B ) . Babies in group B received a conservative nutritional regimen while group A received a package of more aggressive parenteral and enteral nutrition . Statistical analysis was done using Student’st test , the Mann-Whitney U test , the χ2 test and logistic regression . RESULTS There was an excess of sicker babies in group A , as measured by initial disease severity ( P < 0.01 ) , but mean total energy intakes were significantly higher ( P < 0.001 ) in group A at days 3 to 42 while receiving total or partial parenteral nutrition . Survival and the incidences of bronchopulmonary dysplasia , septicaemia , cholestasis , osteopenia and necrotising enterocolitis were similar in both groups . Growth in early life and at discharge from hospital was significantly better in babies in group A. There were no decreases in pulmonary morbidity or hospital stay . CONCLUSION Nutritional intake in sick VLBW infants can be improved without increasing the risk of adverse clinical or metabolic sequelae . Improved nutritional intake result ed in better growth , both in the early neonatal period and at hospital discharge , but did not decrease pulmonary morbidity or shorten hospital stay OBJECTIVE Late-onset sepsis ( occurring after 3 days of age ) is an important problem in very low birth weight ( VLBW ) infants . To determine the current incidence of late-onset sepsis , risk factors for disease , and the impact of late-onset sepsis on subsequent hospital course , we evaluated a cohort of 6956 VLBW ( 401 - 1500 g ) neonates admitted to the clinical centers of the National Institute of Child Health and Human Development Neonatal Research Network over a 2-year period ( 1998 - 2000 ) . METHODS The National Institute of Child Health and Human Development Neonatal Research Network maintains a prospect i ve registry of all VLBW neonates admitted to participating centers within 14 days of birth . Exp and ed infection surveillance was added in 1998 . RESULTS Of 6215 infants who survived beyond 3 days , 1313 ( 21 % ) had 1 or more episodes of blood culture-proven late-onset sepsis . The vast majority of infections ( 70 % ) were caused by Gram-positive organisms , with coagulase-negative staphylococci accounting for 48 % of infections . Rate of infection was inversely related to birth weight and gestational age . Complications of prematurity associated with an increased rate of late-onset sepsis included patent ductus arteriosus , prolonged ventilation , prolonged intravascular access , bronchopulmonary dysplasia , and necrotizing enterocolitis . Infants who developed late-onset sepsis had a significantly prolonged hospital stay ( mean length of stay : 79 vs 60 days ) . They were significantly more likely to die than those who were uninfected ( 18 % vs 7 % ) , especially if they were infected with Gram-negative organisms ( 36 % ) or fungi ( 32 % ) . CONCLUSIONS Late-onset sepsis remains an important risk factor for death among VLBW preterm infants and for prolonged hospital stay among VLBW survivors . Strategies to reduce late-onset sepsis and its medical , social , and economic toll need to be addressed urgently OBJECTIVES To test the hypothesis that the administration of 2.4 g amino acids (AA)/(kg.d ) to very low birth weight infants is safe and results in a positive nitrogen balance . STUDY DESIGN We conducted a r and omized , clinical trial . Preterm infants with birth weights < 1500 g received either glucose and 2.4 g AA/(kg.d ) from birth onward ( n=66 ) or solely glucose during the first day with a stepwise increase in AA intake to 2.4 g AA/(kg.d ) on day 3 ( n=69 ) . Blood gas analysis was performed daily during the first 6 postnatal days ; blood urea nitrogen levels were determined on days 2 , 4 , and 6 ; AA plasma concentrations and nitrogen balances were determined on days 2 and 4 . Student t tests , Mann-Whitney tests , and chi2 tests were performed to compare groups . RESULTS Infants supplemented with AA had no major adverse side effects . Their blood urea nitrogen levels were higher , nitrogen balance turned positive upon AA administration , and more  AA concentrations were within reference ranges . CONCLUSIONS High-dose AA administration to very low birth weight infants can be introduced safely from birth onward and results in an anabolic state OBJECTIVES . The goal was to measure the effects of 2 distinct strategies for parenteral nutrition on  neonatal growth and blood amino acid profiles . METHODS . In a multicenter trial ( n = 11 sites ) , we r and omly allocated premature ( 23–29 weeks and 6 days of gestation ) neonates to 1 of 2 approaches to intravenous amino acid administration . In one group , amino acid supplementation was started at 1.0 g/kg per day and advanced by 0.5 g/kg per day to a maximum of 2.5 g/kg per day ( 2.5 g/kg per day group ) . The other group received amino acids starting at 1.5 g/kg per day and advancing by 1.0 g/kg per day to a maximum of 3.5 g/kg per day ( 3.5 g/kg per day group ) . Filter paper blood spots were obtained from each infant on the day of r and om assignment and on days 7 and 28 of age , to monitor blood amino acid levels . RESULTS . We enrolled 122 neonates ( 64 in the 3.5 g/kg per day group and 58 in the 2.5 g/kg per day group ) . There were no differences in demographic or baseline characteristics between the 2 treatment groups . There was no significant difference in growth by day 28 after birth ( median weight gain : 12.9 and 11.4 g/kg per day for the 3.5 and 2.5 g/kg per day groups , respectively ) , and the incidences of secondary morbidities were similar in the 2 groups . On day 7 , blood levels of several amino acids and the serum urea nitrogen level were higher in the 3.5 g/kg per day group , compared with the 2.5 g/kg per day group ; none of the amino acid levels were lower . CONCLUSIONS . Higher doses of amino acid supplementation did not improve neonatal growth and were associated with increased blood amino acid and urea nitrogen levels OBJECTIVE To examine the changes in plasma amino acid ( AA ) concentrations over time when extremely low birth weight infants are provided either a st and ard intravenous AA supplementation ( st and ard AA ) or an early and high supplementation regimen ( early and high AA ) . STUDY DESIGN Sixty-two infants were enrolled at birth in a r and omized , double-masked , prospect i ve fashion and treated for 7 days . The infants with st and ard AA concentrations received intravenous AA starting at 0.5 g/kg/d and increased by 0.5 g/kg every day to a maximum of 3 g/kg/d . Infants in the early and high AA group received 2 g/kg/d of intravenous AA soon after birth and advanced by 1 g/kg every day to 4 g/kg/d . Plasma AA concentrations were determined by high-pressure liquid chromatography on days 1 , 3 , and 7 . RESULTS Total AA concentrations , total essential AA concentrations , and total nonessential AA concentrations were significantly higher in the infants in the early and high AA group ; essential AA concentrations and total AA concentrations were higher at 1 and 3 days , and nonessential AA concentrations were different only on day 3 . There were significant differences between st and ard AA and early and high AA groups for all AA concentrations except the nonessential AAs Glu , Asn , Gly , Gln , Ala , and Tyr and the conditionally essential AA Cys . CONCLUSION Infants who received early and higher parenteral AA had higher plasma AA concentrations OBJECTIVE To compare the effect of 2.5 vs 4 g/kg/d of amino acid ( AA ) in parenteral nutrition of extremely low birth weight infants on metabolic tolerance , short-term growth , and neurodevelopment . STUDY DESIGN One hundred thirty-one infants with birth weight between 500 and 1249 g were r and omized to 2.5 ( st and ard AA [ SAA ] group ) or 4 ( high AA [ HAA ] group ) g/kg/d AA intake , with equal nonprotein energy . The primary outcome was body size at 36 weeks . RESULTS One hundred thirty-one patients were r and omized and 114 analyzed ( 58 SAA group and 56 HAA group ) . Study groups had similar demographics and clinical characteristics . Elevated blood urea ( BU > 70 mg/dL = BU nitrogen > 32.6 mg/dL ) occurred in 24 % vs 59 % ( P = .000 ) and hyperglycemia ( > 175 mg/dL ) in 34 % vs 11 % ( P = .003 ) of the SAA and HAA patients , respectively . Body weight , length , and head circumference at 36 weeks and 2 years were similar between groups . Bayley Scales of Infant and Toddler Development , Third Edition score was 94 ± 13 in the SAA group and 97 ± 15 in the HAA group ( P = .35 ) . CONCLUSIONS The HAA group had higher BU levels and better glucose control . An extra 8 g/kg of AA over the first 10 days of life did not improve growth and neurodevelopment Objectives To study the effects of early parenteral amino acid administration on body weight , fluid compartments and metabolic parameters during the first week of life in sick premature infants . Methods Appropriate for gestational age , sick premature infants were r and omized into two groups . Group A infants ( n = 8 , birth weight 1258 ± 339 g ) were supplemented with amino acids starting within 24 h of birth and advanced to 2.5 g/kg per day by day 3 . Group G infants ( n = 9 , birth weight 1182 ± 214 g ) received amino acids starting on day 4 of life . Energy intake was comparable in the 2 groups . Amino acid concentrations and nitrogen balance studies were performed on day 3 of life . Total body water and extracellular water were measured on day 1 and 8 and change in intracellular volume was calculated . Results There was no significant difference between the 2 groups in terms of weight , intracellular volume change from day 1 to day 8 of life , despite a significant ( P < 0.01 ) difference in protein intake . Plasma ammonia levels were comparable in the 2 groups , but plasma urea levels were significantly higher in group A vs. group G infants ( 7.2 ± 3.4 mmol/L vs. 3.2 ± 1.2 mmol/L respectively , P < 0.01 ) . Nitrogen balance was positive in all group A infants and negative in group G infants . Nitrogen loss was inversely correlated with energy intake in group G infants ( P < 0.05 ) . The mean plasma amino acid concentrations in group A infants ( compared to those of group G ) were within previously reported ranges in older premature infants . Conclusions There was no significant effect on body weight and redistribution of body fluid compartments in infants receiving amino acids early during the first week of life . Serum urea concentrations were significantly higher in infants receiving early amino acids  . Nitrogen losses in infants who did not receive amino acids were inversely correlated with energy intake during the first 3 days of life Greater protein intakes are required than have been commonly used to achieve fetal in utero protein accretion rates in preterm neonates . To study the efficacy and safety of more aggressive amino acid intake , we performed a prospect i ve r and omized study in 28 infants [ mean wt , 946 ± 40 g ( SEM ) ] of 1 ( low amino acid intake , LAA ) versus 3 g·kg−1·d−1 ( high amino acid intake , HAA ) at 52.0 ± 3.0 h of life . After a minimum of 12 h of parenteral nutrition , efficacy was determined by protein balance and was significantly lower in the LAA versus HAA groups by both nitrogen balance ( −0.26 ± 0.11 versus 1.16 ± 0.15 g·kg−1·d−1 , p < 0.00005 ) and leucine stable isotope ( 0.184 ± 0.17 versus 1.63 ± 0.20 g·kg−1·d−1 , p < 0.0005 ) methods . Leucine flux and oxidation and nonoxidative leucine disposal rates were all significantly higher in the HAA versus LAA groups ( 249 ± 13 versus 164 ± 8 , 69 ± 5 versus 32 ± 3 , and 180 ± 10 versus 132 ± 8 μmol·kg−1·h−1 , respectively , p < 0.005 ) , but leucine appearance from protein breakdown was not ( 140 ± 15 in HAA versus 128 ± 8 μmol·kg−1·h−1 ) . In terms of possible toxicity with HAA , there were no significant differences between groups in the amount of sodium bicarbonate administered , degree of acidosis as determined by base deficit , or blood urea nitrogen concentration . Parenteral HAA versus LAA intake result ed in increased protein accretion , primarily by increasing protein synthesis versus suppressing protein breakdown , and appeared to be well tolerated by very preterm infants in the first days of life
Objectives : Providing parenteral amino acids to very-low-birth-weight infants during the first weeks of life is critical for adequate growth and neurodevelopment .
However , there is no consensus about what dose is appropriate or when to initiate supplementation .
As a result , daily practice varies among neonatal intensive care units .
The objective of our study was to determine the effects of early parenteral amino-acid supplementation ( within 24 h of birth ) versus later initiation and high dose ( > 3.0 g/kg/day ) versus a lower dose on growth and morbidities .