Metabolic responses to early and high protein supplementation in a randomized trial evaluating the prevention of hyperkalemia in extremely low birth weight infants.
OBJECTIVE
To determine whether early and higher intravenous amino acid (EHAA) supplementation decreases hyperkalemia in extremely low birth weight (ELBW) infants (<1000 g).


METHODS
Infants were enrolled at birth in a randomized, double-masked, prospective fashion and treated for 7 days. The standard group (SAA) infants received intravenous amino acid (AA) starting at 0.5 g x kg(-1) x d(-1) and increased by 0.5 g x kg(-1) every day to a maximum of 3 g x kg(-1) x d(-1). EHAA group infants received 2 g x kg(-1) x d(-1) of AA soon after birth and advanced by 1 g x kg(-1) every day to 4 g x kg(-1) x d(-1). Data analysis was by SPSS 11.5, with statistical significance at alpha = 0.05 and 90% power to determine a difference in mean K(+) level of 2.


RESULTS
Sixty-two patients, mean gestational age of 26.0 +/- 2.0 weeks and birth weight of 775 +/- 136 g, were enrolled. Hyperkalemia (K(+) > or =6.5 mEq/L) occurred in 13% of the studied population; no difference in incidence of hyperkalemia was found between the SAA and EHAA groups (16% vs 10%, respectively, P = .70). Serum blood urea nitrogen was higher in the EHAA group. AA infusion was stopped early in 6 patients for high blood urea nitrogen or elevated ammonia level.


CONCLUSIONS
During the study period, hyperkalemia decreased significantly and was not affected by EHAA supplementation in the first week of life.
Blanco
Cynthia Liudmilla
CL
Department of Pediatrics, University of Texas Health Science Center, San Antonio, TX 78229-3900, USA. blanco@uthscsa.edu
Falck
Alison
A
Green
Belinda Kay
BK
Cornell
John E
JE
Gong
Alice Kim
AK
D000596:Amino Acids / Q000008:administration & dosage*; D001806:Blood Urea Nitrogen; D019587:Dietary Supplements; D006801:Humans; D006947:Hyperkalemia / Q000378:metabolism / Q000517:prevention & control*; D052577:Infant, Extremely Low Birth Weight / Q000378:metabolism*; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000378:metabolism / Q000517:prevention & control*; D010289:Parenteral Nutrition, Total; D011446:Prospective Studies
D000596:Amino Acids