title: Early amino acids and the metabolic response of ELBW infants (< or = 1000 g) in three time periods.
abstract: 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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, University of Louisville, Louisville, KY 40292, USA. paula.radmacher@louisville.edu
authors.forename: P G
authors.initials: PG
authors.lastname: Radmacher
authors.forename: S L
authors.initials: SL
authors.lastname: Lewis
authors.forename: D H
authors.initials: DH
authors.lastname: Adamkin