Effect of intravenous amino acids on glutamine and protein kinetics in low-birth-weight preterm infants during the immediate neonatal period. Randomised trial of early diet in preterm babies and later intelligence quotient A controlled trial of glucose versus glucose and amino acids in premature infants. Early provision of parenteral amino acids in extremely low birth weight infants: relation to growth and neurodevelopmental outcome. [Intensive early amino acid supplementation is efficacious and safe in the management of preterm infants]. Intravenous nitrogen and energy intakes required to duplicate in utero nitrogen accretion in prematurely born human infants. Early macronutrient intake and overweight at five years of age A Randomized Controlled Trial on Parenteral Nutrition, Oxidative Stress, and Chronic Lung Diseases in Preterm Infants Early diet in preterm babies and developmental status at 18 months Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants Aggressive Early Total Parental Nutrition in Low-Birth-Weight Infants The effect of short-term total parenteral nutrition on hepatic function in the human neonate: a prospective randomized study demonstrating alteration of hepatic canalicular function. Low birthweight infants and total parenteral nutrition immediately after birth. II. Randomised study of biochemical tolerance of intravenous glucose, amino acids, and lipid. Safety and efficacy of early amino acids in preterm <28 weeks gestation: prospective observational comparison Peripheral total parenteral nutrition for premature infants with the respiratory distress syndrome: a controlled study. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1993 through December 1994. Randomized, Controlled Trial of Early Intravenous Nutrition for Prevention of Neonatal Jaundice in Term and Near-term Neonates A randomised multicentre study of human milk versus formula and later development in preterm infants. Amino acid administration to premature infants directly after birth. Early introduction of parenteral nutrition in premature infants and its effect on calcium and phosphate homeostasis. National Institute of Child Health and Human Development The Effects of Early Parenteral Amino Acids on Sick Premature Infants Longitudinal Growth of Hospitalized Very Low Birth Weight Infants Immediate commencement of amino acid supplementation in preterm infants: effect on serum amino acid concentrations and protein kinetics on the first day of life. Effect of Low versus High Intravenous Amino Acid Intake on Very Low Birth Weight Infants in the Early Neonatal Period
Glutamine may be a conditionally essential amino acid in low-birth-weight ( LBW ) preterm neonates . Exogenously administered amino acids , by providing anaplerotic carbon into the tricarboxylic acid cycle , could result in greater cataplerotic efflux and glutamine de novo synthesis . The effect of dose and duration of amino acid infusion on glutamine and nitrogen ( N ) kinetics was examined in LBW infants in the period immediately after birth . Preterm neonates ( < 32 weeks gestation , birth weights 809 - 1,755 g ) were r and omized to initially receive either 480 or 960 micromol x kg(-1 ) x h(-1 ) of an intravenous amino acid solution for 19 - 24 hours , followed by a higher or lower amino acid load for either 5 h or 24 h. Glutamine de novo synthesis , leucine N , phenylalanine , and urea kinetics were determined using stable isotopic tracers . An increase in  amino acid infusion from 480 to 960 micromol x kg(-1 ) x h(-1 ) for 5 h result ed in decreased glutamine de novo synthesis in every neonate ( 384.4 + /- 38.0 to 368.9 + /- 38.2 micromol x kg(-1 ) x h(-1 ) , P < 0.01 ) and a lower whole body rate of proteolysis ( P < 0.001 ) and urea synthesis ( P < 0.001 ) . However , when the increased amino acid infusion was extended for 24 h , glutamine de novo synthesis increased ( 369.7 + /- 92.6 to 483.4 + /- 97.5 micromol x kg(-1 ) x h(-1 ) , P < 0.001 ) , whole body rate of proteolysis did not change , and urea production increased . Decreasing the amino acid load result ed in a decrease in glutamine rate of appearance ( R(a ) ) and leucine N R(a ) , but had no effect on phenylalanine R(a ) .  Acutely stressed LBW infants responded to an increase in amino acid load by transiently suppressing whole body rate of glutamine synthesis , proteolysis , and oxidation of protein . The mechanisms of this transient effect on whole body protein/nitrogen metabolism remain unknown 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 A controlled study comparing two intravenous fluid regimens was performed in sick , premature infants . The regimens were isocaloric at 60 calories/kg/day , one providing glucose alone , the other glucose plus 2.5 gm/kg of amino acids . There was no difference in changes in body weight between the two groups ; infants receiving glucose alone were in negative nitrogen balance ; those receiving glucose plus amino acids were in positive nitrogen balance . Plasma amino acid values were compared to published , postpr and ial normal values . The TEAA and TAA of infants receiving amino acids were not different from normal . Values of TEAA and TAA of infants receiving glucose alone were significantly lower . Essential fatty acid deficiency developed in infants receiving amino acids but not in those receiving glucose alone . It is concluded that the glucose plus amino acid regimen results in anabolism without undue metabolic costs 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 OBJECTIVE To evaluate the efficacy and safety of the parenteral administration of various quantities of amino acid in preterm infants . METHODS Preterm infants ( birth weight 1000 - 2000 g ) recruited into the study were r and omized into three groups . High amino acid group ( HP ) : 2.4 g/(kg.d ) of amino acid IV within 24 hours after birth increasing by increments of 1.2 g/(kg.d ) to a maximum of 3.6 g/(kg . d ) ; medium amino acid group ( MP ) : 1.0 g/(kg.d ) of amino acid IV 24 hours after birth , increasing by increments of 0.5 g/(kg.d ) until a maximum of 3.0 g/(kg.d ) ; and low amino acid group ( LP ) : 0.5 g/(kg.d ) of amino acid on D3 , increasing by increments of 0.5 g/(kg.d ) until a maximum of 3.0 g/(kg.d ) as the final dose . RESULTS Totally 96 preterm infants were recruited : HP 34 , MP 32 and LP 30 . There were no significant differences in demographic or clinical characteristics among the 3 groups . HP group showed lower postnatal weight loss ( 43.4 g , 95 % CI 74.3 , 12.6 ) and weight loss% ( 2.84 % , 95 % CI 4.79 % , 0.71 % ) than LP group . HP group showed shorter length of stay in NICU ( 5.25 d ) , days to reach 2000 g ( 7.03 d ) and days to tolerate 100 kcal/(kg.d ) enteral nutrition ( 4.52 d ) than LP group . Cost of hospitalization was significantly lower in HP group than in LP group ( -6275 RMB , 1 US$ = 8 RMB ) and MP group ( -5715 RMB ) . Mean serum RBP ( D4 ) , threonine and tyrosine levels were significantly higher in HP group than in LP group . Serum insulin levels were similar ; mean serum glucose level was lower in HP group than in LP group . HP infants had lower incidence of sepsis than LP infants ( 21.9 % vs 40.0 % ) . There were no significant differences in the levels of blood ammonia , acid-base balance ( as determined by pH and NaHCO3- ) , BUN , Cr , AST , and ALT . CONCLUSIONS Intensive and early administration of intravenous amino acid [ 2.4 g/(kg.d ) ] improves  preterm infants ' growth and the tolerance of enteral feeding . It also reduces the cost of hospitalization , and the incidence of sepsis In order to determine the intravenous energy and nitrogen intakes required to achieve intrauterine rates of nitrogen accretion and growth , 30 studies were completed in 22 premature infants who were provided with various intakes of amino acids and energy ( glucose + /- lipid ) by peripheral vein infusion .  At constant nitrogen intake , increasing energy intake ( as lipid ) from 50 to 80 nonprotein kcal/kg/day result ed in significant increases in nitrogen retention and weight gain . Increasing nitrogen intake from 494 to 655 mg/kg/day at constant low energy intake ( mean = 53 kcal/kg/day ) had no effect on nitrogen retention or weight change ; however , at higher energy intakes ( mean = 81 kcal/kg/day ) increasing nitrogen intake correlated significantly with increasing nitrogen retention . At energy intakes greater than 70 kcal/kg/day the major determinant of nitrogen retention was nitrogen intake . When energy intake was greater than 70 kcal/kg/day , the infusion of nitrogen providing 430 to 560 mg/kg/day ( 2.7 to 3.5 gm protein/kg/day ) result ed in the duplication of intrauterine nitrogen accretion rates OBJECTIVE : To examine the influence of the macronutrient intake in early life on the development of  overweight in children . DESIGN AND SUBJECTS : An ongoing longitudinal study including 147 r and omized healthy children followed up from birth . MEASUREMENTS : Anthropometric parameters were measured at birth , 1 and 5 y of age . Dietary habits at the age of 1 and 5 were assessed by age-adjusted food-frequency question naires and 24 h recalls .  Parents ’ body mass index ( BMI ) was also recorded . RESULTS :  Parental overweight was observed for 51 % children . The prevalence of overweight at the age of 5 y was higher in children with than without parental overweight ( 37.3 % vs 8.3 % , P<0.0001 ) . Five-year old overweight children had a higher percentage intake of proteins at the age of 1 y than non overweight children ( 22 % vs 20 % , P=0.024 ) and lower intake of carbohydrates ( 44 % vs 47 % , P=0.031 ) . Multiple logistic analysis confirmed that protein intake at 1 y of age was associated with overweight at 5 y ( P=0.05 ) . In children born from overweight mothers , prevalence of overweight at the age of 5 y tended to be higher in bottle-fed than in breast-fed ones ( 62.5 % vs 23.3 % , P=0.08 ) . CONCLUSION : Parental overweight is a major risk factor for childhood overweight in the first years of life , but an early high protein intake may also influence the development of adiposity Objectives : To evaluate the effect of trace elements ( TEs ) , when added to total parenteral nutrition ( TPN ) solutions , on peroxides load , and to test the hypothesis that protection of TPN from light can decrease peroxides load and is associated with improvement in oxidant-related clinical outcomes in preterm infants . Subjects and Methods : A total of 80 preterm infants were r and omized to 1 of 4 groups ( n = 20 each ) : group 1 received a mixture of dextrose and amino acids ; group 2 received a mixture of dextrose , amino acids , and lipid emulsion ; group 3 received dextrose , amino acids , lipid emulsion , and multivitamins ( MVP ) ; and group 4 received dextrose , amino acids , lipid emulsion , MVP , and TEs . Each group was subdivided into photo-protected and photo-exposed subgroups ( n = 10 each ) . Using ferrous oxidation of xylenol orange technique , we measured the baseline level of excreted urinary peroxides before and 48 hours after starting TPN . We examined the association among light protection , urinary peroxides , and clinical outcomes of these infants . Results : Baseline urinary peroxides ranged between 5.5 and 24.8 μmol/L. A significant increase in urinary peroxides was observed in all groups after receiving TPN . The use of TEs did not affect peroxide production . In regression analysis , the addition of MVP ( P < 0.0001 ) and the exposure to light ( P = 0.02 ) were significantly associated with increased urinary peroxides . In the overall population , light exposure was associated with a significant increase in the incidence of chronic lung disease ( adjusted OR 9.26 , confidence interval 1.2–73 ; P = 0.03 ) but had no effect on mortality , necrotizing enterocolitis , or sepsis . Conclusions : TEs in TPN solutions have no effect on the production of urinary peroxides . Addition of MVP and exposure of TPN to light are the 2 major sources of peroxides in TPN . Protection from ambient light is associated with a decrease in chronic lung disease 424 preterm infants were r and omly assigned a st and ard " term " formula or a nutrient-enriched " preterm " formula as sole diets ( trial A ) or as supplements to mother 's own expressed milk ( trial B ) for a median of 4 weeks postnatally . 18 months post term , blind evaluation of 377 survivors showed that those previously fed preterm rather than term formula had major developmental advantages , more so in motor than mental function ; the advantages , in both mental and motor scores , were especially striking in small-for-gestational-age infants and in males . For motor development index in trial A , this advantage was 15 points ; in infants born small for gestation , it was 23 points ( nearly 1.5 SD ) . Moderate developmental impairment ( developmental index less than 85 ) , notably motor impairment , was considerably more common in the group fed term formula . Infants fed preterm formula also had a small benefit in social maturity quotient . Thus , a short period of early dietary manipulation in preterm infants had major consequences for later development , which suggests that the first weeks may be critical for nutrition 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 : This study aim ed to compare nitrogen balance and biochemical tolerance of early aggressive versus late total parenteral nutrition in very-low-birth-weight ( VLBW ) infants over the first week of life . STUDY DESIGN : In all , 32 ventilator-dependent preterm infants were prospect ively r and omized into two groups . The Early Total Parenteral Nutrition ( ETPN ) group received 3.5 g/kilo-day amino acids ( AA ) , and 3 g/kilo-day of 20 % Intralipid ( IL ) , starting within 1 hour after birth . The Late Total Parenteral Nutrition group ( LTPN ) , started on a solution containing glucose during the first 48 hours of life , followed by 2 g/kilo-day of AA and 0.5 g/kilo-day of IL . For the LTPN group AA and IL were each increased by 0.5 g/kilo-day to a maximum of 3.5 and 3 g/kilo-day , respectively . RESULTS : Nitrogen retention was significantly greater in all infants in the ETPN group throughout the 7-day study period . All infants in the LTPN group were in negative nitrogen balance during the first 48 hours of life , while those in the ETPN group were in positive nitrogen balance throughout . The mean ( ±SD ) nitrogen retention in the ETPN was 384.5 mg/kilo-day ( ±20.2 ) , compared to 203.4 mg/kilo-day ( ±20.9 ) in the LTPN group ( p < 0.001 ) . In each of the first 5 days of life , energy intake was significantly greater in the ETPN group compared to the LTPN group ( p < 0.001 ) . Mean fluid intake during the study period was similar between , the ETPN and the LTPN groups ( 162 and 165 cm3/kilo-day , respectively ) . The mean weight gain was similar in the ETPN and LTPN groups . Plasma levels of cholesterol , triglycerides , bicarbonate , blood urea nitrogen , creatinine , and pH were similar in both groups during the study period . Mean ( ±SD ) serum glucose in the LTPN group was higher , but remained in normal range ( 101.1±5.2 and 80.8±5.4 mg/kilo-day , respectively ) . The mean peak serum bilirubin was significantly higher in the ETPN group , compared to The LTPN group ( 7.7 and 6.2 mg/dl ) . CONCLUSION : This study shows that aggressive intake of AA and IL can be tolerated immediately after birth by VLBW infants . Also , ETPN significantly increased positive nitrogen balance and caloric intake , without increasing the risk of metabolic acidosis , hypercholesterolemia , or hypertriglyceridemia Twenty-one infants who were c and i date s for TPN because of respiratory disease were r and omized into experimental ( TPN ) and control ( glucose-electrolyte ) groups . Serum GOT , GPT , GGTP , 5 ' nucleotidase , total , direct , and conjugated ( ethyl anthranilate-reactive ) bilirubin , and bile salt concentrations were determined at entry into the study and at one week . One week of TPN caused significant elevations of GGTP , 5'-N and EA bilirubin values , whereas SGOT , SGPT , SBS , and total and direct bilirubin were unaffected . Addition of a lipid infusion to TPN did not alter these differences . These data are interpreted as showing : ( 1 ) amino acid infusion has an early effect on hepatic function which is independent of the many diseases for which this therapy is used and of the concomitant use of lipid ; ( 2 ) the initial effect appears to be on the canalicular membrane ; and ( 3 ) the sinusoidal membrane is apparently unaffected by one week of TPN This r and omised study aim ed to compare the biochemical tolerance of three parenteral regimens administered during the first 48 hours of life . Twenty nine infants were r and omised to either : ( a ) glucose 10 % ; ( b ) glucose 10%/amino acids ; ( c ) glucose 10%/amino acids/lipid . Blood sample s for plasma amino acid profiles , cholesterol , and triglyceride concentrations were taken on arrival in the neonatal unit and again between 36 and 48 hours of life .  Arterial or capillary blood gas analysis and blood glucose estimates  were performed routinely during the first 48 hours of life . There was a sharp decline in plasma amino acid concentrations in the group following ( a ) compared with the two groups following ( b ) and ( c ) regimens . In all groups plasma triglyceride and cholesterol were not significantly different before and after 48 hours of lipid infusion . Peak mean ( SE ) bilirubin concentrations ( 203 ( 12 ) v 181 ( 19 ) v 220 ( 20 ) mumol/l ) and the need for phototherapy ( nine v eight v five infants ) were similar for each of the groups . Hypoglycaemia occurred most frequently during the ( b ) regimen and least commonly in the ( c ) group . There are potential health gains from giving parenteral nutrition to low birthweight infants immediately after birth , and this study indicates that restriction of nutritional intake immediately after birth in preterm infants may cause significant metabolic disturbance . This can be prevented by starting a regimen of intravenous amino acids and lipid immediately after birth Objective : To assess the safety and efficacy of early amino acid ( AA ) administration  in preterm neonates < 28 weeks gestational age . Study design : Prospect i ve data collection for 1 year for the  late AA group ( AA started at 12–30 h ) and for another year with practice change to early AA administration ( immediately after stabilization ) . Results : Time of initiation of AA differed ( early group 4±3 h vs late group 20±6 h ; P<0.001 ) . There were no statistically significant differences in the incidence of clinical ly significant metabolic acidosis . Blood urea at 24 h was higher in the early AA group . No significant differences in growth rate or neonatal outcomes were identified . Days to regain birth weight and sepsis were lower in the early AA group . Conclusions : Early AA administration was not associated with any clinical ly significant adverse effects ; it was associated with reduction in the incidence of sepsis and marginally effective in reducing time to regain birth weight In 40 premature infants , in whom severe respiratory distress precluded oral feeding ,  peripheral total parenteral nutrition consisting of casein hydrosylate , dextrose , and soybean emulsion was compared to nutrition with dextrose and electrolytes . The TPN group received more calories , and the total serum protein in them increased significantly . Metabolic complications did not occur . Transient thrombocytosis occurred in six infants who received TPN and eosinophilia occurred in nine . The case fatality rate in the TPN group ( three of 20 ) was not significantly less than in the glucose group ( six of 20 ) . The differences suggested that infants who weigh less than 1,500 gm may receive the greater benefit from TPN OBJECTIVES Our purpose was to determine the mortality and morbidity rates for infants weighing 501 to 1500 g according to gestational age , birth weight , and gender . STUDY DESIGN Perinatal data were collected prospect ively on an inborn cohort from January 1993 through December 1994 by 12 participating centers of the National Institute of Child Health and Human Development Neonatal Research Network and were compared with the corresponding data from previous reports . Sociodemographic factors , perinatal events , and the neonatal course to 120 days of life , discharge , or death were evaluated . RESULTS Eighty-three percent of infants survived until discharge to home or to a long- term care facility ( compared with 74 % in 1988 ) . Survival to discharge was 49 % for infants weighing 501 to 750 g at birth , 85 % for those 751 to 1000 g , 93 % for those 1001 to 1250 g , and 96 % for those 1251 to 1500 g. The majority of deaths occurred within the first 3 days of life . Mortality rates were greater for male than for female infants . Respiratory distress syndrome was the most frequent pulmonary disease ( 52 % ) . Chronic lung disease ( defined as an oxygen requirement at 36 weeks after conception ) developed in 19 % . Thirty-two percent of infants had evidence of intracranial hemorrhage . Periventricular leukomalacia was noted in 6 % of infants who had ultrasonography after 2 weeks . The average duration of hospitalization for survivors was 68 days ( 122 days for surviving infants weighing 501 to 750 g , compared with an average of 43 days for surviving infants 1251 to 1500 g ) . Among infants who died , the average length of stay was 19 days . CONCLUSIONS The mortality rate for infants weighing between 501 and 1500 g at birth continues to decline . This increase in survival is not accompanied by an increase in medical morbidity . There are interactions between birth weight , gestational age , sex , and survival rates Background : This study was undertaken to investigate the effects of early parenteral nutrition on prevention of  neonatal jaundice in term and near-term neonates who could not be enterally fed . Patients and Methods : Seventy-two infants were r and omized into 2 groups : the early parenteral nutrition group ( group 1 ) received 1.0 g/kg/d amino acids beginning within the first day and 1.0 g/kg/d lipid added the next day . The conventional nutrition group ( group 2 ) started on a solution containing 10 % glucose and electrolytes in the first 72 hours of life , followed by 0.5 g/kg/d amino acids and lipid . Amino acids and lipid were each increased by 0.5 g/kg/d to a maximum of 3.0 g/kg/d in both groups . Main outcome measures were energy intake ; serum bilirubin levels at 24 , 48 , and 72 hours ; need for phototherapy ; and duration of phototherapy . Results : Higher energy intake was achieved after the first day in group 1 . Daily serum bilirubin levels did not significantly differ between groups . Nine patients in each group required phototherapy . The initiation times of phototherapy were 92.9 hours ± 25.5 in group 1 and 83.1 hours ± 28.5 in group 2 . Duration s of phototherapy were 37.3 hours ± 11.1 in group 1 and 52.0 hours ± 20.7 in group 2 . There were no significant differences in the requirement , initiation time , and duration of phototherapy . Conclusions : Early parenteral nutrition has no proven benefit in terms of therapy requirement or severity and duration of neonatal jaundice compared with conventional parenteral nutrition in term and near-term infants who could not be enterally fed Whether breast milk influences later neurodevelopment  has been explored in non-r and omised studies , potentially confounded by social and demographic differences between feed groups . Here in a strictly r and omised prospect i ve multicentre trial , Bayley psychomotor and mental development indices ( PDI and MDI ) were assessed at 18 months postterm in survivors of 502 preterm infants assigned to receive , during their early weeks , mature donor breast milk or a preterm formula .  These diets were compared as sole enteral feeds or as supplements to the mother 's expressed breast milk . No differences in outcome at 18 months were seen between the two diet groups despite the low nutrient content of donor milk in relation to the preterm formula and to the estimated needs of preterm infants . These results contrast with those reported from our parallel two centre study that compared infants r and omly assigned a st and ard term formula or the preterm formula during their early weeks ; those fed st and ard formula , now regarded as nutritionally insufficient for preterm infants , were substantially disadvantaged in PDI and MDI at 18 months post-term . It is shown here that infants from that study fed solely on st and ard formula had significantly lower developmental scores at 18 months than those fed on donor breast milk in the present study ; yet the st and ard formula had a higher nutrient content than the donor milk . Thus , donor milk feeding was associated with advantages for later development that may have offset any potentially deleterious effects of its low nutrient content for preterm infants . As these outcome advantages were not confounded by the social and educational biases usually associated with mothers ' choice to breast feed , our data add significant support to the view that breast milk promotes neurodevelopment 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 Calcium and phosphate homeostasis was evaluated in two matched groups of sick premature neonates .  Parenteral nutrition in the form of an amino acid solution was administered to 10 infants ( group A ) , and a dextrose-electrolyte-calcium solution was administered to 11 infants ( group B ) . The infants did not demonstrate the immediate phosphaturia previously described following infusion of amino acids and /or glucose . In both groups , phosphate excretion was directly related to phosphate intake ( r = 0,45 ; P less than 0,001 ) . In group A infants infusion of the amino acid solution was associated with a significantly greater fall in serum calcium levels on the 2nd day of life ( P = 0,02 v. group B ) , despite similar intake and excretion of calcium in the two groups . We suggest that the phosphate content of the amino acid solution may aggravate the neonate 's tendency to hypocalcaemia , although frank hyperphosphataemia was not observed The National Institute of Child Health and Human Development conducts and supports research on all stages of human development from preconception to adulthood in order to better underst and the health of children , youths , adults , families , and communities . Health and human development information is made easily available on the site with a simple A to Z list , along with clinical trials and health education campaign information . Links to clinical trials , news releases , publications , and related web sites are also available , as well as information on research being conducted at present and supported by the National Institute of Child Health and Human Development 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 Background . The interpretation of growth rates for very low birth weight infants is obscured by limited data , recent changes in perinatal care , and the uncertain effects of multiple therapies . Objectives . To develop contemporary postnatal growth curves for very low birth weight preterm infants and to relate growth velocity to birth weight , nutritional practice s , fetal growth status ( small- or appropriate-for-gestational-age ) , and major neonatal morbidities ( chronic lung disease , nosocomial infection or late-onset infection , severe intraventricular hemorrhage , and necrotizing enterocolitis ) . Design . Large , multicenter , prospect i ve cohort study . Methods . Growth was prospect ively assessed for 1660 infants with birth weights between 501 to 1500 g admitted by 24 hours of age to 1 of the 12 National Institute of Child Health and Human Development Neonatal Research Network centers between August 31 , 1994 and August 9 , 1995 . Infants were included if they survived > 7 days ( 168 hours ) and were free of major congenital anomalies .  Anthropometric measures ( body weight , length , head circumference , and midarm circumference ) were performed from birth until discharge , transfer , death , age 120 days , or a body weight of 2000 g. To obtain representative data , nutritional practice s were not altered by the study protocol . Results . Postnatal growth curves suitable for clinical and research use were constructed for body weight , length , head circumference , and midarm circumference . Once birth weight was regained , weight gain ( 14.4–16.1 g/kg/d ) approximated intrauterine rates . However , at hospital discharge , most infants born between 24 and 29 weeks of gestation had not achieved the median birth weight of the reference fetus at the same postmenstrual age . Gestational age , race , and gender had no effect on growth within 100-g birth weight strata . Appropriate-for-gestational age infants who survived to hospital discharge without developing chronic lung disease , severe intraventricular hemorrhage , necrotizing enterocolitis , or late onset-sepsis gained weight faster than comparable infants with those morbidities . More rapid weight gain was also associated with a shorter duration of parenteral nutrition providing at least 75 % of the total daily fluid volume , an earlier age at the initiation of enteral feedings , and an earlier age at achievement of full enteral feedings . Conclusions . These growth curves may be used to better underst and postnatal growth , to help identify infants developing illnesses affecting growth , and to aid in the design of future research . They should not be taken as optimal . R and omized clinical trials should be performed to evaluate whether different nutritional management practice s will permit birth weight to be regained earlier and result in more rapid growth , more appropriate body composition , and improved short- and long-term outcomes To determine whether the general reluctance to begin amino acid administration to preterm infants from birth onward might lead to loss of lean body mass and impairment of growth , we measured amino acid levels and protein kinetics in 18 preterm infants . Nine infants received amino acids ( 1.15 + /- 0.06 gm.kg-1.day-1 ) and glucose ( 6.05 + /- 1.58 gm.kg-1.day-1 ) , whereas the other nine infants received only glucose ( 6.48 + /- 1.30 gm.kg-1.day-1 ) from birth onward . Protein kinetics on the first postnatal day were measured with a stable isotope dilution technique with [1 - 13C]leucine as a tracer . No statistically significant differences were noted in blood pH , base excess , urea concentration , or glucose levels . Both total amino acid concentration and total essential amino acid concentration were significantly lower and were below the reference range in the nonsupplemented group . Plasma amino acid levels of five essential amino acids ( methionine , cystine , isoleucine , leucine , arginine ) were below the reference range in the nonsupplemented group , whereas only cystine was below the reference range in the supplemented group . Nitrogen retention was improved significantly by the administration of amino acids ( -110 + /- 44 mg nitrogen per kilogram per day in the glucose-only group vs + 10 + /- 127 mg nitrogen per kilogram per day in the group given glucose and amino acids ; p = 0.001 ) ; leucine oxidation was not significantly increased in the supplemented group ( 41 + /- 13 mumol.kg-1.hr-1 vs 46 + /- 16 mumol.kg-1.hr-1 ) . Leucine balance also improved significantly ( -41 + /- 13 mumol.kg-1.hr-1 vs -8 + /- 16 mumol.kg-1.hr-1 ; p = 0.01 ) because of a combination of an increased amount of leucine being used for protein synthesis and a lower amount of leucine coming from protein breakdown . Plasma cystine concentration , the only amino acid below the reference range in the supplemented group , was highly predictive for protein synthesis in that group . We conclude that the administration of amino acids to preterm infants from birth onward seems safe and prevents the loss of protein mass 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
BACKGROUND Observational studies in preterm newborns suggest that delay in administering amino acids could result in a protein catabolic state and could impact on growth and development .
OBJECTIVES To determine the effect of early administration of amino acids in premature newborns on growth , neurodevelopmental outcome , mortality and clinical ly important side effects .