Neonatal Med.  2018 Nov;25(4):153-160. 10.5385/nm.2018.25.4.153.

Tolerability and Effect of Early High-Dose Amino Acid Administration in Extremely Low Birth Weight Infants

• Choi JW
• Kim J
• Ahn SY
• Chang YS
• Park WS
• Sung SI

• KMID: 2436133
• DOI: http://doi.org/10.5385/nm.2018.25.4.153

Abstract

PURPOSE
The aim of this study is to examine the tolerability and effect of early highdose amino acid administration in extremely low birth weight infants (ELBWIs).
METHODS
This retrospective cohort study included ELBWI (birth weight < 1,000 g, n=142). Biochemical, nutritional, and neurodevelopmental data were compared between infants who received conventional low amino acid (LAA; 1.5 g/kg/day) and those who received high amino acid (HAA; 3 g/kg/day) within the first 48 hours after birth. Neurodevelopmental data included weight, height, and head circumference at discharge, 12 to 14 and 18 to 24 months of corrected age and the Korean Bayley Scale of Infant Development II (K-BSID-II) score at 18 to 24 months of corrected age.
RESULTS
The HAA group demonstrated higher peak plasma albumin (3.0±0.4 vs. 3.2±0.5, P < 0.05) and lower serum creatinine (1.7±0.9 vs. 1.4±0.8, P < 0.05) during the first 14 days than the LAA group. Full enteral feeding was achieved significantly earlier in infants in the HAA group than in infants in the LAA group (46.2±23.0 days vs. 34.3±21 days, P < 0.01). There was no difference between the two groups in the z score changes in all growth indicators from birth to discharge and at 12 to 14 and 18 to 24 months of corrected age, as well as in the K-BSID-II score at 18 to 24 months of corrected age.
CONCLUSION
Aggressive administration of amino acids during the first 2 days of life in ELBWI was well tolerated and correlated with earlier full enteral feeding, but did not improve growth and neurodevelopment.

Keyword

High dose amino acid; Parenteral nutrition; Growth; Extremely low birth weight infant

MeSH Terms

Amino Acids
Child
Child Development
Cohort Studies
Creatinine
Enteral Nutrition
Head
Humans
Infant*
Infant, Extremely Low Birth Weight
Infant, Low Birth Weight*
Infant, Newborn
Parenteral Nutrition
Parturition
Retrospective Studies
Serum Albumin
Amino Acids
Creatinine
Serum Albumin

Figure

• 

  Figure 1. Amino acid, glucose, lipid intake, and nonprotein kilocalorie to nitrogen (NPC:N) ratios of the low amino acid (LAA) and high amino acid (HAA) groups. (A) Total average amino acid intake, (B) total average glucose intake, (C) total average lipid intake, and (D) average NPC:N ratio. *P<0.05.

• 

  Figure 2. Z score changes of growth parameters in the low amino acid (LAA) and high amino acid (HAA) groups from birth to discharge and at 12 to 14 and 18 to 24 months of corrected age (CA). (A) Weight, (B) height, and (C) head circumference (HC).

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