title: Safety and efficacy of early parenteral lipid and high-dose amino acid administration to very low birth weight infants.
abstract: OBJECTIVE
  To assess the efficacy and safety of early parenteral lipid and high-dose amino acid (AA) administration from birth onwards in very low birth weight (VLBW, birth weight <1500 g) infants.
  
  
  METHODS
  VLBW infants (n = 144; birth weight 862 ± 218 g; gestational age 27.4 ± 2.2 weeks) were randomized to receive 2.4 g of AA kg(-1) · d(-1) (control group), or 2.4 g AA kg(-1) · d(-1) plus 2-3 g lipids kg(-1) · d(-1) (AA + lipid group), or 3.6 g AA kg(-1) · d(-1) plus 2-3 g lipids kg(-1) · d(-1) (high AA + lipid group) from birth onwards. The primary outcome was nitrogen balance. The secondary outcomes were biochemical variables, urea rate of appearance, growth rates, and clinical outcome.
  
  
  RESULTS
  The nitrogen balance on day 2 was significantly greater in both intervention groups compared with the control group. Greater amounts of AA administration did not further improve nitrogen balance compared with standard AA dose plus lipids and was associated with high plasma urea concentrations and high rates of urea appearance. No differences in other biochemical variables, growth, or clinical outcomes were observed.
  
  
  CONCLUSIONS
  In VLBW infants, the administration of parenteral AA combined with lipids from birth onwards improved conditions for anabolism and growth, as shown by improved nitrogen balance. Greater levels of AA administration did not further improve the nitrogen balance but led to increased AA oxidation. Early lipid initiation and high-dose AA were well tolerated.
authors: Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors: Hester
authors: H
authors: Vlaardingerbroek
authors: Marijn J
authors: MJ
authors: Vermeulen
authors: Denise
authors: D
authors: Rook
authors: Chris H P
authors: CH
authors: van den Akker
authors: Kristien
authors: K
authors: Dorst
authors: Josias L
authors: JL
authors: Wattimena
authors: Andras
authors: A
authors: Vermes
authors: Henk
authors: H
authors: Schierbeek
authors: Johannes B
authors: JB
authors: van Goudoever
mesh_terms: D000596:Amino Acids / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood / Q000652:urine; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000254:growth & development / Q000378:metabolism / Q000502:physiology*; D016014:Linear Models; D008055:Lipids / Q000008:administration & dosage*; D016015:Logistic Models; D008297:Male; D009584:Nitrogen / Q000652:urine; D010288:Parenteral Nutrition / Q000379:methods*; D057947:Parenteral Nutrition Solutions / Q000008:administration & dosage / Q000737:chemistry*; D014508:Urea / Q000097:blood
chemical_list: D000596:Amino Acids; D015415:Biomarkers; D008055:Lipids; D057947:Parenteral Nutrition Solutions; D014508:Urea; D009584:Nitrogen
keywords: AA; Amino acid; ECF; Ethyl chloroformate; NICU; Neonatal intensive care unit; ROP; Retinopathy of prematurity; SGA; Small for gestational age; TG; Triacylglycerol; VLBW; Very low birth weight