Protein balance in the first week of life in ventilated neonates receiving parenteral nutrition

Thureen, Patti J.; Anderson, Anne H.; Baron, Karen A; Melara, Diane L; Hay, William W.; Fennessey, Paul V.

doi:10.1093/ajcn/68.5.1128

Cited by 77 publications

(57 citation statements)

References 27 publications

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“…As seen in Table 3, very preterm infants have very high leucine rates of appearance from protein breakdown and nonoxidative leucine disposal (reflecting rates of protein breakdown and synthesis, respectively) when compared with the rate of leucine balance. These data further substantiate previous observations of significantly higher protein synthesis and breakdown rates in very low birth weight infants (11,16,19,33,34).…”

supporting

confidence: 91%

“…In this study efficacy of increased amino acid intake was determined by protein balance (presumed protein accretion rate) as determined by nitrogen balance and leucine stable isotope methods. As we have seen previously in a similar population (19), there was a strong correlation between the two methods in determination of protein balance (r 2 ϭ 0.661, p Ͻ 0.0001), although protein balance values tended to be higher by the isotope method (Fig. 2).…”

supporting

confidence: 82%

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Effect of Low versus High Intravenous Amino Acid Intake on Very Low Birth Weight Infants in the Early Neonatal Period

Thureen

2003

Pediatric Research

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Greater protein intakes are required than have been commonly used to achieve fetal in utero protein accretion rates in preterm neonates. To study the efficacy and safety of more aggressive amino acid intake, we performed a prospective randomized study in 28 infants [mean wt, 946 Ϯ 40 g (SEM)] of 1 (low amino acid intake, LAA) versus 3 g·kg Ϫ1 ·d Ϫ1 (high amino acid intake, HAA) at 52.0 Ϯ 3.0 h of life. After a minimum of 12 h of parenteral nutrition, efficacy was determined by protein balance and was significantly lower in the LAA versus HAA groups by both nitrogen balance (Ϫ0. Abbreviations PN, parenteral nutrition LAA, low amino acid intake HAA, high amino acid intake Int leuc , leucine intake rate Q leuc , leucine flux rate Ox leuc , leucine oxidation rate NOD leuc , nonoxidative leucine disposal intake rate RP leuc , rate of leucine appearance from protein breakdown ELBW, extremely low birth weight BUN, blood urea nitrogen GCMS, gas chromatography-mass spectroscopyThe current standard for postnatal nutrition in all preterm infants is one that duplicates normal in utero fetal growth rates (1). Owing to advances in perinatal care, more very preterm infants are surviving. These infants have unique nutritional metabolic requirements for growth, predicted by low energy stores, high protein flux rate, and a high metabolic rate as a result of a relatively larger mass of metabolically active organs. Nevertheless, it is common practice in many neonatal intensive care units to limit nutrient administration, particularly amino acids, to ELBW or sick neonates in the early neonatal period because of concerns of substrate intolerance. Several studies suggest that this delay in nutrition results in postnatal malnutrition that produces measurable growth failure at hospital discharge (2-4).Although strategies to improve growth necessitate delivery of larger amounts of both energy and protein beginning shortly after birth, there are reasons to suggest that focusing on protein delivery may be particularly important. Throughout life, maximal weight-specific protein gain occurs before 32 wk gestation (5). Data from studies in fetal animal models suggest that amino acid metabolic rates may be a much more sensitive indicator than growth rate of adequate nutrition before term (6). Additionally, recent data suggest that long-term developmental outcome in the preterm may be correlated with early protein intake (7

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supporting

confidence: 91%

supporting

confidence: 82%

Effect of Low versus High Intravenous Amino Acid Intake on Very Low Birth Weight Infants in the Early Neonatal Period

Thureen

2003

Pediatric Research

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“…[1][2][3][4][5] Without the provision of exogenous AA after delivery, the extremely low birth weight (ELBW) infant will become catabolic, losing as much as 1% of protein stores daily because of on-going proteolysis. 6 Despite an increasing body of literature that supports the provision of intravenous AA within hours of birth to prevent this proteolysis, [7][8][9][10][11][12] practices continue to vary across nurseries in the United States because of concerns about metabolic capabilities of the ELBW infant.…”

Section: Introductionmentioning

confidence: 99%

Early amino acids and the metabolic response of ELBW infants (⩽1000 g) in three time periods

2009

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Objective: To evaluate early amino-acid (AA) administration in extremely low birth weight (ELBW) infants over three time periods, beginning with the initiation of this strategy. Study design:This was a retrospective study of ELBW infants between 2000 and 2007. Nutritional intake and laboratory results were monitored during the first 5 days of life. Growth rates and complications were followed until discharge.Result: Infants were similar in birth weight (BW), gestational age (GA) and severity of illness. The age at initiation of AA decreased significantly over time. Age at weight nadir, return to BW and percent postnatal weight loss decreased in epoch 3. There were modest increases in blood urea nitrogen (BUN), but no significant metabolic disturbances were observed. Cholestasis was more prevalent in epoch 2.Conclusion: AA administration within the first hours of life appears to be safe and beneficial for ELBW infants. Absent signs of renal dysfunction, a modest rise in BUN is consistent with the neonate's utilization of AAs for energy.

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“…Inadequate nutritional supplementation is directly linked to EUGR 10,11 and likely exacerbates recovery and healing from other neonatal morbidities, such as BPD. [12][13][14] Early amino-acid supplementation dramatically improves the nitrogen balance of ELBW infants, shifting these patients from the catabolic state traditional parenteral support induces to a healthier anabolic state.…”

Section: Introductionmentioning

confidence: 99%

Improved growth and decreased morbidities in <1000 g neonates after early management changes

et al. 2008

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Objective: To test the hypothesis that three changes in the early management of extremely low birth weight (ELBW) neonates would decrease the incidence of extra-uterine growth restriction (EUGR) by 25%. The three early management practice changes (EMPC) included surfactant at delivery followed by immediate extubation to nasal continuous positive airway pressure (CPAP), decreased oxygen exposure and early parenteral amino acids.

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Protein balance in the first week of life in ventilated neonates receiving parenteral nutrition

Abstract: Ill neonates can achieve a positive protein balance in the first days of life without laboratory evidence of protein toxicity.

Cited by 77 publications

References 27 publications

Effect of Low versus High Intravenous Amino Acid Intake on Very Low Birth Weight Infants in the Early Neonatal Period

Effect of Low versus High Intravenous Amino Acid Intake on Very Low Birth Weight Infants in the Early Neonatal Period

Early amino acids and the metabolic response of ELBW infants (⩽1000 g) in three time periods

Improved growth and decreased morbidities in <1000 g neonates after early management changes

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