Effect of Intravenous Amino Acids on Protein Metabolism of Preterm Infants during the First Three Days of Life

Rivera, Audelio; Bell, Edward F.; Bier, Dennis M.

doi:10.1203/00006450-199302000-00003

Cited by 213 publications

(97 citation statements)

References 16 publications

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“…This appears in contrast with previous data by Rivera et al (1993) who did not find any influence of AA input on kalemia, in a small randomized trial, and by Elstgeest et al (2010) who compared, in a retrospective study, two different PN regimens, but having also a very dissimilar fluid and electrolyte intake, in the first days of life. Na/K-ATPase impairment is often recognized as responsible for non-oliguric hyperkalemia.…”

Section: Discussioncontrasting

confidence: 55%

“…The effect of nutrition on electrolyte balance in the preterm infant F Bonsante et al studies assessing cellular metabolism by nitrogen balance. In these studies, nitrogen balance was always positive in the groups with an AA intake of more than 2 g/kg/day and always negative for less then 1.5 g/kg/day (Van Lingen et al, 1992;Mitton et al, 1993;Rivera et al, 1993;Wahlig et al, 1994;Van Goudoever et al, 1995;Thureen et al, 2003). Moreover, the relationship between total body K and protein content is well established in the preterm baby (Spady et al, 1987).…”

Section: Discussionmentioning

confidence: 81%

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The effect of parenteral nitrogen and energy intake on electrolyte balance in the preterm infant

et al. 2011

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Background/Objectives: Recent guidelines for preterm parenteral nutrition (PN) recommend an earlier and higher intake of amino acids (AA) and energy to avoid postnatal catabolism and approximate normal fetal growth. Few investigations explored how early PN may affect electrolyte and water homeostasis. We performed a prospective observational trial to assess the effect of nutrient intake on electrolyte homeostasis and balance. Subjects/Methods: During 16 months, all infants p32 weeks were eligible. In the first week of life, we recorded the following daily: electrolytes (plasma and 8-h urine collection), nutritional intake, urine output, body weight, and we calculated sodium (Na) and potassium (K) balance. Infants were divided, for analysis, into three groups of AA intake: low o1.5 g/kg/day (LAA), medium 1.5-2 g/kg/day (MAA) and high 42 g/kg/day (HAA). Results: A total of 154 infants were included. HAA group presented lower weight loss. Na balance was influenced by urine output and postnatal age, with little contribution of nutrition. Kalemia and K balance were mainly influenced by AA intake. K balance differed among groups: LAA, À2.3 mmol/kg/week; MAA, 1.1 mmol/kg/week; and HAA 2.6 mmol/kg/week (Po0.0001). In the HAA group, plasma and urine K were significantly lower and non-oliguric hyperkalemia was reduced. Conclusions: Na homeostasis was very slightly modified by early nutrition, suggesting that a negative Na balance is obligatory after birth. We showed that AA intake strongly affects K balance, minimize hyperkalemia and reduces weight loss. As K balance is strictly linked to cellular metabolism, we speculate that early nutrition may inhibit cellular catabolism and reduce the contraction of intracellular water compartment.

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Section: Discussioncontrasting

confidence: 55%

Section: Discussionmentioning

confidence: 81%

The effect of parenteral nitrogen and energy intake on electrolyte balance in the preterm infant

et al. 2011

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“…1,19 Although early administration of only 1-1.5 g/kg/day of amino acids parenterally can minimize or prevent the loss of body protein stores, significantly higher intakes are needed to promote growth and prevent increased deficits. [26][27][28][29] It has been estimated that, to attain intrauterine rates of protein deposition, around 4 g/kg/day of amino-acid intake may be required in the smallest VLBW infants. 30 Additional proteins and calories for 'catch up' growth are usually necessary to compensate for any loss of lean body mass that occurred before the infant regains birth weight.…”

Section: Discussionmentioning

confidence: 99%

Early and aggressive nutritional strategy (parenteral and enteral) decreases postnatal growth failure in very low birth weight infants

Dinerstein¹,

Nieto²,

Solana³

et al. 2006

J Perinatol

152

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Objective: To compare postnatal growth and nutritional deficits after the implementation of two different nutritional strategies in two consecutives periods of time.Methods: An early and aggressive nutritional regimen was used in a cohort of 117 very low birth weight (VLBW) infants. Amino acids were administered at the rate of 1.5 g/kg/day along with 5.6 mg/k/min of glucose flow on day 1 of life, and progressively increased to 4 g/kg/day and 13 mg/kg/min. Intravenous lipids were started at 0.5 g/kg/day at 24 h from birth, and increased to 3.5 g/kg/day; enteral feeding was begun at day 1 of life. Uni-and multivariate analyses were used to compare this group with the conventional group of 65 VLBW infants conservatively fed.Results: Univariate analysis showed that in the aggressive group there was a 66% reduction in the risk of post natal malnutrition at 40 weeks of postmenstrual age (OR 0.34; 95% CI 0.17-0.67). This difference persisted in the multivariate analysis. Energy and protein deficits were lower in the aggressive group (P<0.001).Conclusions: Early and aggressive introduction of total parenteral nutrition and enteral feeding resulted in better growth in weight, length and head circumference, and a reduction of nutritional deficits at 40 weeks of postmenstrual age.

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“…[8][9][10][11][12][13][14][15][16][17][18][19] Many of these studies have shown that an amino-acid intake of between 1.5 and 2.0 g/kg/day, when given with Z30 kcal/kg/day of non-protein calories, is sufficient to avoid negative nitrogen balance in neonates. 12 With the goal of replicating intrauterine protein accretion rates, aminoacid intakes are estimated to be 3.5 to 4.0 g/kg/day particularly for ELBW infants <1000 g. 13,14 A strong argument for the early aggressive use of amino acids is the prevention of ''metabolic shock.''…”

Section: Introductionmentioning

confidence: 99%

“…Irrepressible glucose production may be the cause of the so-called glucose intolerance that often limits the amount of energy that can be administered to the ELBW infant. It is noteworthy that Rivera et al 19 made the surreptitious observation that glucose tolerance was substantially improved in the group receiving early amino acids. Early amino acids may stimulate insulin secretion, consistent with the notion that forestalling the starvation response improves glucose tolerance.…”

Section: Introductionmentioning

confidence: 99%

Pragmatic Approach to In-Hospital Nutrition in High-Risk Neonates

Adamkin

2005

J Perinatol

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Effect of Intravenous Amino Acids on Protein Metabolism of Preterm Infants during the First Three Days of Life

Cited by 213 publications

References 16 publications

The effect of parenteral nitrogen and energy intake on electrolyte balance in the preterm infant

The effect of parenteral nitrogen and energy intake on electrolyte balance in the preterm infant

Early and aggressive nutritional strategy (parenteral and enteral) decreases postnatal growth failure in very low birth weight infants

Pragmatic Approach to In-Hospital Nutrition in High-Risk Neonates

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