Safety and Efficacy of Early Parenteral Lipid and High-Dose Amino Acid Administration to Very Low Birth Weight Infants

Vlaardingerbroek, Hester; Vermeulen, Marijn J.; Rook, Denise; Akker, Chris H.P. van den; Dorst, Kristien; Wattimena, J.L.D.; Vermes, András; Schierbeek, Henk; Goudoever, Johannes B. van

doi:10.1016/j.jpeds.2013.03.059

Cited by 145 publications

(178 citation statements)

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“…40,41 We found a significantly higher incidence of elevated blood urea concentrations in the groups receiving the DISCUSSION NIHR Journals Library www.journalslibrary.nihr.ac.uk RDI of amino acids. This is also in keeping with the studies of Vlaardingerbroek et al, 35,67 although there was no associated increased incidence of metabolic acidosis. The significance of elevated blood urea in the early postnatal period in preterm infants is unclear.…”

Section: Resultssupporting

confidence: 91%

“…This suggests that increased delivery above a threshold results in increased amino acid oxidation with no improvement in nitrogen retention or growth, as suggested previously. 35,75,76 We consider it unlikely that impaired utilisation of amino acids was attributable to inadequate non-protein energy delivery, as there were no significant differences between the groups in non-protein energy intakes. Second, trial interventions may have resulted in a short-term difference in body composition that was attenuated when babies transitioned to self-regulated suck feeds.…”

Section: Resultsmentioning

confidence: 99%

“…However, higher intake of amino acids from day 1 did not further improve the nitrogen balance, but led to increased amino acid oxidation. 35 Although there is concern that undernutrition is associated with adverse neurodevelopmental outcomes, there is also some suggestion that 'overnutrition' may also be detrimental to neurodevelopment. 73 As noted above, there are animal data reporting an association between PN and adverse neurodevelopment when compared with enteral nutrition.…”

Section: Resultsmentioning

confidence: 99%

“…There was no improvement in nitrogen balance with greater amounts of amino acids. 35 A systematic review of the early introduction of lipids (defined as introduction within the first 2 days after birth) and the use of new lipid emulsions included 14 RCTs. 36 Early initiation of lipids had no impact on any of the outcome measures, including death, bronchopulmonary dysplasia, necrotising enterocolitis, patent ductus arteriosus, sepsis, intraventricular haemorrhage, significant jaundice and hypertriglyceridaemia.…”

Section: Previous Studies Of Parenteral Nutritionmentioning

confidence: 99%

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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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Section: Resultssupporting

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Previous Studies Of Parenteral Nutritionmentioning

confidence: 99%

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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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“…1,5,[13][14][15][16] Lipids emulsions help to reach the high caloric requirements of preterm and are the unique source of essential fatty acids. Lipids should account for 25-40% of non-protein calories.…”

Section: Lipidsmentioning

confidence: 99%

Feeding of preterm infants and fortification of breast milk

Mangili

Garzoli

2017

Pediatr Med Chir

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The administration of the adequate amount of nutrients helps to improve a correct short-term linear growth and long-term neurocognitive development. To reduce the extra-uterine growth delay in very low birth weight infants (VLBW) the best strategy of nutrition (parenteral or enteral) should be established rapidly, since the first day of life. In preterm infants, nutrition can be administered parenterally and enterally. Prematurity is the most frequent indication for parenteral nutritional support due to intestinal functional immune deficiency, deficiency of digestive enzymatic systems and reduced nutritional reserve of these infants. In terms of enteral nutrition, breast milk is the first choice. In case of preterm and VLBW infants, fortifiers are used to overcome breast milk's protein and mineral deficiencies. When breast milk is not available, specific infant formula is the alternative. IntroductionThe improvement of neonatal care has led to an increase in the survival rate of very low birth weight infants (VLBW) infants (<1500 g). Nonetheless, growth failure is still a very frequent issue with incidence that ranges from 43 to 97% among various neonatal units. Thus, more aggressive nutritional strategies have been developed: first the parenteral nutrition then the enteral nutrition. Parenteral nutrition is often the only source of nutrients that can be used during the period of clinical instability. 1 Enteral nutrition must be gradually introduced as soon as possible; in presence of a good enteral tolerance, the parenteral nutrition should be rapidly discontinued, thus reducing its related side effects. 2 Parenteral nutritionAssuring an adequate nutrition to preterm infants is a real challenge, especially during the first hours after birth, when a total parenteral nutrition (TPN) is needed to meet the high nutritional requirements but it is often complicated by glucose and lipids intolerance. 3 Parenteral nutrition (PN) is an intravenous nutritional therapy that includes the administration of fluids, electrolytes, glucose, proteins, lipids, minerals, vitamins and oligo-elements. 4 It should be started as soon as possible within the first 24 hours of life. It can be prescribed in individualized or standardized administration; PN is provided through a central catheter (umbilical vein catheter or percutaneous central catheter) or, temporarily, via a peripheral route in the case of partial parenteral solutions and low osmolar load (<600 mOsm/L). Fluids and electrolytesIn the first week of life changes occur in the extracellular and intracellular compartments, resulting in a redistribution of fluids. This is one of the reason that explains the weight loss (5-10% of birth weight) that usually takes place during the first days of life. The fluid intake in the newborn (VLBW) and very low birth weight (ELBW) starts with 80-90 mL/kg/day and then is gradually increased by 10-20 mL/kg/day up to 160-180 and 150-160 mL/kg/day, respectively. 2,5-8 Electrolytic supplementation usually begins on the third-fourth day of...

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Higher versus lower amino acid intake in parenteral nutrition for newborn infants

Osborn

Schindler

Jones

et al. 2018

Cochrane Database of Systematic Reviews

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Safety and Efficacy of Early Parenteral Lipid and High-Dose Amino Acid Administration to Very Low Birth Weight Infants

Cited by 145 publications

References 43 publications

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

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

Feeding of preterm infants and fortification of breast milk

Higher versus lower amino acid intake in parenteral nutrition for newborn infants

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