Impact of Early and High Amino Acid Supplementation on ELBW Infants at 2 Years

Blanco, Cynthia L.; Gong, Alice; Schoolfield, John; Green, Belinda K.; Daniels, W.H.; Liechty, Edward A.; Ramamurthy, Rajam S.

doi:10.1097/mpg.0b013e31824887a0

Cited by 98 publications

(116 citation statements)

References 20 publications

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“…Eight studies compared low- versus high-dose amino-acid supplementation [13,16,23,24,25,26,27,28], 5 studies compared early versus late supplementation [12,29,30,31,32], and 3 studied both [16,33,34,35]. Three studies, from Blanco et al [33,34,35], were based on the same study population and were, therefore, seen as one. Six studies included co-interventions in their feeding protocol: 2 compared early versus late amino-acid supplementation [12,32] and 4 studied low- versus high-dose supplementation [13,25,27,28].…”

Section: Resultsmentioning

confidence: 99%

Low- versus High-Dose and Early versus Late Parenteral Amino-Acid Administration in Very-Low-Birth-Weight Infants: A Systematic Review and Meta-Analysis

Leenders

Waard²,

Goudoever³

2017

Neonatology

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Objectives: Providing parenteral amino acids to very-low-birth-weight infants during the first weeks of life is critical for adequate growth and neurodevelopment. However, there is no consensus about what dose is appropriate or when to initiate supplementation. As a result, daily practice varies among neonatal intensive care units. The objective of our study was to determine the effects of early parenteral amino-acid supplementation (within 24 h of birth) versus later initiation and high dose (>3.0 g/kg/day) versus a lower dose on growth and morbidities. Methods: A systematic review and meta-analysis of publications identified by searching PubMed, EMBASE, and Cochrane databases was conducted. Randomized controlled studies were eligible if information on growth was available. Results: The search identified 14 studies. No differences were observed in growth or morbidity after early or high-dose amino-acid supplementation, but for several outcomes, meta-analysis was not possible due to study heterogeneity. Initiation of amino acids within the first 24 h of life appeared to be safe and well tolerated, and leads more rapidly to a positive nitrogen balance. Conclusions: Administering a high dose (>3.0 g/kg/day) or an early dose (≤24 h) of parenteral amino acids is safe and well tolerated but does not offer significant benefits on growth. Further large-scale randomized controlled trials in preterm infants are needed to study the effects of early and high-dose amino acids on growth and morbidity more consistently and extensively.

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Section: Resultsmentioning

confidence: 99%

Low- versus High-Dose and Early versus Late Parenteral Amino-Acid Administration in Very-Low-Birth-Weight Infants: A Systematic Review and Meta-Analysis

Leenders

Waard²,

Goudoever³

2017

Neonatology

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“…Other investigators have reported similar results. [1][2][3][4][5] Establishing a consensus regarding what represents a normal metabolic profile in premature infants would allow investigators to identify infants with abnormal values and to evaluate the impact of those abnormal values on important health outcomes (liver injury, growth, and neurodevelopmental outcomes). Failure to establish normal values undermines our understanding of amino acid and fatty acid metabolism in premature infants.…”

mentioning

confidence: 99%

Gestational Age and Age at Sampling Influence Metabolic Profiles in Premature Infants

Clark,

Kelleher,

Chace

et al. 2014

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Prematurely born infants commonly have abnormal metabolic screens.WHAT THIS STUDY ADDS: Both gestational and chronological age influence metabolic profiles used to screen for inborn errors of metabolism.abstract OBJECTIVE: To describe the influence that gestational age and chronological age have on amino acid and acylcarnitine profiles in an atrisk population of premature infants. METHODS:Metabolic profiles (15 amino acids and 35 acylcarnitines) were obtained by using standard newborn techniques on infants born between 23 and 31 completed weeks of gestation. The profiles were drawn within the first 24 hours after birth and on approximately days 7, 28, and 42 of life or at discharge. A single, central, contract laboratory analyzed and managed the samples. RESULTS:We studied 995 patients; none was subsequently diagnosed with an inborn error of metabolism. Of the 3579 samples, there were 257 (7.2%) amino acid or acylcarnitine alerts reported in 214 infants (21.5% of infants studied). Both gestational age and postbirth chronological age significantly influenced the metabolic profile. Twenty-nine percent of infants at 23 to 26 weeks' gestational age had an abnormal metabolic profile compared with 17% of infants at 29 to 31 weeks' gestational age (P , .01). On the day of birth, 12% of the profiles were abnormal compared with 2% on day 28 (P , .01). The highest rate of abnormal values occurred on day 7 in the infants 23 to 26 weeks' gestational age (21%).CONCLUSIONS: These results demonstrate the complexity of understanding the impact of immaturity and disease on metabolic profiles used to screen for inborn errors of metabolism. Dr Clark has contributed to the conception and design of the study. The article from first to final draft was written and edited by Dr Clark with the help of his co-authors who offered suggestions for improvement; Mrs Kelleher has contributed to the drafting and revising of the article for important intellectual content; Dr Chace has contributed to the conception and design of the study analysis and interpretation of data; Dr Spitzer has contributed to the conception and design of the study, analysis and interpretation of data, and critical revisions for important intellectual content; and all authors approved the final manuscript as submitted.This trial has been registered at www.clinicaltrials.gov (identifier NCT00865150). METHODS Study SubjectsWe included inborn infants between the gestational ages of 23 weeks and 0/7 days and 31 weeks and 0/7 days and excluded infants if they had major congenital anomalies. Parental consent was obtained for each subject. The protocol was approved by the Western Institutional Review Board and/or each site' s local institutional review board. Nutritional SupportFluid management and nutritional guidelines were used as per site specific protocol. Data on precisely what was received by the study subject and growth parameters were collected on postnatal days 1, 7, 28, and 42. Metabolic ProfilesAn experienced health care professional...

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“…Choudri et al 69 found smaller brain growth and compromised neurodevelopment despite equivalent weight gain in preterm piglets receiving total parenteral in comparison with total enteral nutrition. Blanco et al 70 found that infants receiving an immediate parenteral amino acid intake of 2 g/kg/day increasing to 4 g/kg/day, compared with a group randomised to receive a lower intake, had a lower mean Mental Development Index at 18 months and lower mean z-scores for weight, length and head circumference. Reassuringly, in the NEON trial we identified no between-group differences in brain volume.…”

Section: Resultsmentioning

confidence: 99%

Nutritional Evaluation and Optimisation in Neonates (NEON) trial of amino acid regimen and intravenous lipid composition in preterm parenteral nutrition: a randomised double-blind controlled trial

et al. 2016

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Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising.The WestminsterResearch online digital archive at the University of Westminster aims to make the research output of the University available to a wider audience. Copyright and Moral Rights remain with the authors and/or copyright owners.Whilst further distribution of specific materials from within this archive is forbidden, you may freely distribute the URL of WestminsterResearch: ((http://westminsterresearch.wmin.ac.uk/).In case of abuse or copyright appearing without permission e-mail repository@westminster.ac.uk This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/). EFFICACY AND MECHANISM EVALUATION Efficacy and Mechanism EvaluationEditorial contact: nihredit@southampton.ac.ukThe full EME archive is freely available to view online at www.journalslibrary.nihr.ac.uk/eme. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Efficacy and Mechanism Evaluation journalReports are published in Efficacy and Mechanism Evaluation (EME) if (1) they have resulted from work for the EME programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. EME programmeThe Efficacy and Mechanism Evaluation (EME) programme was set up in 2008 as part of the National Institute for Health Research (NIHR) and the Medical Research Council (MRC) coordinated strategy for clinical trials. The EME programme is broadly aimed at supporting 'science driven' studies with an expectation of substantial health gain and aims to support excellent clinical science with an ultimate view to improving health or patient care.Its remit includes evaluations of new treatments, including therapeutics (small molecule and biologic), psychological interventions, public health, diagnostics and medical devices. Treatments or interventions intended to prevent disease are also included.The EME programme supports laboratory based or similar studies that are embedded within the main study if relevant to the remit of the EME programme. Studies that use validated surrogate markers as indicators of health outcome are also considered.For more information about the EME programme please visit the website: http://www.nets.nihr.ac.uk/programmes/eme This reportThe research reported in this issue of the journal was funded by the EME programme as project number 08/99/04. The contractual start date was in February 2010. The final report began editorial review in January 2015 and was accepted for publication in October 2015. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The EME edit...

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Impact of Early and High Amino Acid Supplementation on ELBW Infants at 2 Years

Abstract: ELBW infants who received early and high IV AA during the first week of life were associated with poor overall growth at 2 years.

Cited by 98 publications

References 20 publications

Low- versus High-Dose and Early versus Late Parenteral Amino-Acid Administration in Very-Low-Birth-Weight Infants: A Systematic Review and Meta-Analysis

Low- versus High-Dose and Early versus Late Parenteral Amino-Acid Administration in Very-Low-Birth-Weight Infants: A Systematic Review and Meta-Analysis

Gestational Age and Age at Sampling Influence Metabolic Profiles in Premature Infants

Nutritional Evaluation and Optimisation in Neonates (NEON) trial of amino acid regimen and intravenous lipid composition in preterm parenteral nutrition: a randomised double-blind controlled trial

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