title: Albumin synthesis in very low birth weight infants is enhanced by early parenteral lipid and high-dose amino acid administration.
abstract: OBJECTIVE
  Albumin is one of the most important plasma proteins and plays a key role in many physiologic processes, such as preserving colloid osmotic pressure, scavenging radicals, and binding and transporting bilirubin, hormones, and drugs. However, albumin concentrations are often low in preterm infants during the first days of life. We hypothesized that early parenteral lipid and high-dose amino acid (AA) administration to very low birth weight (VLBW) infants from birth onwards increases hepatic albumin synthesis rates.
  
  
  METHODS
  Inborn VLBW infants were randomized to receive from birth onwards either 2.4 g amino acids/(kg(·)d) (control group), 2.4 g amino acids/(kg(·)d) plus 2 g lipids/(kg(·)d) (AA + lipid group), or 3.6 g amino acids/(kg(·)d) plus 2 g lipids/(kg(·)d) (high AA + lipid group). On postnatal day 2, infants received a primed continuous infusion of [U-(13)C6,(15)N]leucine. Mass spectrometry was used to determine the fractional and absolute albumin synthesis rates (FSR and ASR, respectively).
  
  
  RESULTS
  In total, 28 infants (median gestational age 27 weeks (IQR 25-28), median birth weight 810 g (IQR 679-998) were studied. The median FSR was 6.5%/d in the control group, 10.6%/d in the AA group, and 12.3%/d in the high AA + lipid group, while the median was 84 mg/(kg(·)d) in the control group, 138 mg/(kg(·)d) in the AA group, and 160 mg/(kg(·)d) in the high AA + lipid group.
  
  
  CONCLUSIONS
  A group of VLBW infants given parenteral nutrition containing lipids and high-dose amino acids showed a higher rate of albumin synthesis compared to infants receiving no lipids and standard amounts of amino acids during the first two days of life.
authors.affiliation: Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.
authors.forename: Hester
authors.initials: H
authors.lastname: Vlaardingerbroek
authors.affiliation: Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; Department of Pediatrics, Emma Children's Hospital - AMC, c/o Room H7-282, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
authors.forename: Henk
authors.initials: H
authors.lastname: Schierbeek
authors.affiliation: Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.
authors.forename: Denise
authors.initials: D
authors.lastname: Rook
authors.affiliation: Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.
authors.forename: Marijn J
authors.initials: MJ
authors.lastname: Vermeulen
authors.affiliation: Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.
authors.forename: Kristien
authors.initials: K
authors.lastname: Dorst
authors.affiliation: Hospital Pharmacy, Erasmus MC, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.
authors.forename: Andras
authors.initials: A
authors.lastname: Vermes
authors.affiliation: Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands; Department of Pediatrics, Emma Children's Hospital - AMC, c/o Room H7-282, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands; Department of Pediatrics, VU University Medical Center, c/o Room ZH 9D11, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. Electronic address: h.vangoudoever@amc.uva.nl.
authors.forename: Johannes B
authors.initials: JB
authors.lastname: van Goudoever
authors.affiliation: Department of Pediatrics, Division of Neonatology, Erasmus MC - Sophia Children's Hospital, c/o Room SP3433, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands.
authors.forename: Chris H P
authors.initials: CHP
authors.lastname: van den Akker
mesh_terms: D000418:Albumins / Q000096:biosynthesis*; D000596:Amino Acids / Q000008:administration & dosage*; D001724:Birth Weight; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight / Q000097:blood*; D008055:Lipids / Q000008:administration & dosage*; D008297:Male; D010288:Parenteral Nutrition
chemical_list: D000418:Albumins; D000596:Amino Acids; D008055:Lipids
keywords: Anabolism; Growth; Mass spectrometry; Parenteral nutrition; Preterm infant; Stable isotopes