Korean J Pediatr.  2015 Mar;58(3):77-83. 10.3345/kjp.2015.58.3.77.

Nutritional strategy of early amino acid administration in very low birth weight infants

• Lee BS

• KMID: 2149742
• DOI: http://doi.org/10.3345/kjp.2015.58.3.77

Abstract

Relative to a fetus of the same gestational age, very low birth weight (VLBW) infants are more likely to be underfed and to undergo growth restriction during their early hospital stay. The current trend towards "early and aggressive" nutritional strategies in VLBW infants aims to overcome the early nutritional deficiency and thereby boost postnatal catch-up growth, simultaneously improving long-term neurodevelopmental outcomes. Although the minimum starting amino acid (AA) dose to prevent negative nitrogen balance is well established, the upper limit and the rate of increase of early AA doses are controversial. Most randomized controlled trials show that early and high-dose (target, 3.5 to 4.9 g/kg/day) AA regimens, with or without high nonprotein calories, do not improve long-term growth and neurodevelopment. High-dose AA supplementation may lead to early metabolic disturbances and excessive or disproportionate plasma AA levels, particularly in infants of very low gestational age. Further large studies are needed to clarify the optimal strategy for early administration of parenteral AA doses in VLBW infants.

Keyword

Infant; Premature; Amino acids; Parenteral nutrition; Growth and development

MeSH Terms

Amino Acids
Fetus
Gestational Age
Growth and Development
Humans
Infant*
Infant, Very Low Birth Weight*
Length of Stay
Malnutrition
Nitrogen
Parenteral Nutrition
Plasma
Amino Acids
Nitrogen