Albumin synthesis in very low birth weight infants is enhanced by early parenteral lipid and high-dose amino acid administration

ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Lipids

“…To date there is no evidence that gradual increments in the infusion rate of lipids improve fat tolerance. However, starting lipid emulsion the first day of life at a dose of 2e3 g/kg/d may induce a higher occurrence of hyperlipidaemia as indicated above [19].…”

“…In the larger one, the efficacy of the introduction of a high dose of parenteral lipids (i.e., 2e3 g/kg/day) combined with 2.4 g/ kg/day of amino acids from birth onwards was compared to a group receiving a similar amount of amino acids, but without lipids. In the group with parenteral lipids, the nitrogen balance on day two was significantly more positive, plasma urea concentrations were significantly lower, and albumin synthesis was enhanced [19], suggesting that administration of parenteral lipids combined with amino acids from birth onwards improves protein anabolism. On the other hand, triglycerides and glucose concentrations were significantly higher in the early lipid group compared with the control group and more infants required insulin therapy.…”

Parenteral nutrition therapy for neonates: Experience in a tertiary care centre in Sri Lanka

“…A study done in a group of very low birth weight (VLBW) babies who received PN prescriptions with energy and high doses of amino acids were shown to promote protein synthesis more than newborns who received no lipids and standard amounts of amino acids during the first two days of life 18 . This finding suggests that the high amount of amino acid supply has a better outcome in the new tissue laid down among newborns.…”

Nutrición parenteral en situaciones clínicas especiales

“…No obstante, en los últimos años se ha demostrado seguro el aporte inicial de 2,4 g/kg/ día el primer día de vida (4,7,8). Los resultados dependen no solo de la dosis de aminoácidos (AA) sino del aporte concomitante de calorías no proteicas.…”

“…Aportes iniciales superiores (3,6 g/kg/día junto a lípidos) no han demostrado mejorar el balance nitrogenado y se asocian a aumento de urea plasmática que refleja una mayor oxidación de AA (7,9). En un reciente ensayo clínico con RN prematuros < 1.500 g se demostró mayor síntesis de albúmina en 12 pacientes con aporte precoz proteico de 3,6 g/ kg/día junto a lípidos comparados con 9 pacientes que recibieron 2,4 g/kg/día junto a lípidos (8), datos que deben ser refrendados en estudios de mayor tamaño muestral (ver capítulo de "Requerimientos en nutrición parenteral pediátrica" para incrementos posteriores).…”