Randomised controlled trial of acetate in preterm neonates receiving parenteral nutrition.
OBJECTIVE
To determine whether by partly replacing chloride with acetate in parenteral nutrition, hyperchloraemia, metabolic acidosis, and the subsequent use of interventions such as colloid infusion, alkali treatment, increased assisted ventilation, would be reduced.


METHODS
Fifty eight neonates of less than 32 weeks gestation, receiving parenteral nutrition from days 3 to 10, were given either standard parenteral nutrition or a novel formulation with replacement of any chloride dose > 3 mmol/kg/day as acetate.


RESULTS
Acetate (0 to 14.2 mmol/kg/day) reduced the incidence of hyperchloraemia from 77% to 25%, and caused an increase in base excess from day 5 onwards (mean intergroup difference 3.6 to 9.9 mmol/l), an increased pH (day 8, 7.34 vs 7.26), with an increased pCO2 (1 kPa). The acetate group received less bicarbonate (median 0 mmol vs 4.8 mmol) and less colloid (41 ml/kg vs 204 ml/kg). There was no difference in any parameter of assisted ventilation.


CONCLUSIONS
Acetate in neonatal parenteral nutrition reduces metabolic acidosis and hyperchloraemia.
Peters
O
O
Department of Pharmacy, Liverpool Women's Hospital.
Ryan
S
S
Matthew
L
L
Cheng
K
K
Lunn
J
J
D000138:Acidosis / Q000378:metabolism / Q000517:prevention & control*; D002245:Carbon Dioxide / Q000378:metabolism; D002712:Chlorides / Q000097:blood*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature / Q000378:metabolism*; D010288:Parenteral Nutrition; D019346:Sodium Acetate / Q000008:administration & dosage*
D002712:Chlorides; D002245:Carbon Dioxide; D019346:Sodium Acetate