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Amino Acids

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Nutrition for the Preterm Neonate

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Abstract

Neonatologists’ ultimate goal is to achieve a functional outcome in preterm infants that is comparable to outcomes in healthy term-born infants. Current guidelines recommend the initiation of amino acid administration as soon as possible in the first postnatal day at a dose of 2–3 g/kg/day. Within the next few days, amino acid intake should be increased to a maximum amount of 4 g/kg/day. However, actual intakes are still lower than target intakes in many neonatal intensive care units worldwide. Subsequently, many preterm infants fail to grow well, which is associated with long-term consequences with regard to growth and neurodevelopment. While most studies on early amino acid administration show beneficial effects predominantly on short-term outcomes, some studies also warn of adverse effects, especially in extremely immature and extremely low birth weight infants. Future studies should be directed towards elucidating the long-term anthropometric and neurodevelopmental outcomes of early (high dose) amino acid administration.

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References

  1. Berry MA, Abrahamowicz M, Usher RH (1997) Factors associated with growth of extremely premature infants during initial hospitalization. Pediatrics 100:640–646

    Article  PubMed  CAS  Google Scholar 

  2. Stephens BE, Walden RV, Gargus RA et al (2009) First-week protein and energy intakes are associated with 18-month developmental outcomes in extremely low birth weight infants. Pediatrics 123:1337–1343

    Article  PubMed  Google Scholar 

  3. Hay WW Jr, Lucas A, Heird WC et al (1999) Workshop summary: nutrition of the extremely low birth weight infant. Pediatrics 104:1360–1368.

    Article  PubMed  Google Scholar 

  4. Dinerstein A, Nieto RM, Solana CL, Perez GP, Otheguy LE, Larguia AM (2006) Early and aggressive nutritional strategy (parenteral and enteral) decreases postnatal growth failure in very low birth weight infants. J Perinatol 26:436–442

    Article  PubMed  CAS  Google Scholar 

  5. Thureen P, Heird WC (2005) Protein and energy requirements of the preterm/low birthweight (LBW) infant. Pediatr Res 57:95R–98R

    Article  PubMed  Google Scholar 

  6. Hulst JM, van Goudoever JB, Zimmermann LJ et al (2004) The effect of cumulative energy and protein deficiency on anthropometric parameters in a pediatric ICU population. Clin Nutr 23:1381–1389

    Article  PubMed  Google Scholar 

  7. Martin CR, Brown YF, Ehrenkranz RA et al (2009) Nutritional practices and growth velocity in the first month of life in extremely premature infants. Pediatrics 124:649–657

    Article  PubMed  Google Scholar 

  8. Ehrenkranz RA (2000) Growth outcomes of very low-birth weight infants in the newborn intensive care unit. Clin Perinatol 27:325–345

    Article  PubMed  CAS  Google Scholar 

  9. van Goudoever JB, Sulkers EJ, Lafeber HN, Sauer PJ (2000) Short-term growth and substrate use in very-low-birth-weight infants fed formulas with different energy contents. Am J Clin Nutr 71:816–821

    PubMed  Google Scholar 

  10. Kashyap S, Schulze KF, Ramakrishnan R, Dell RB, Heird WC (1994) Evaluation of a mathematical model for predicting the relationship between protein and energy intakes of low-birth-weight infants and the rate and composition of weight gain. Pediatr Res 35:704–712

    Article  PubMed  CAS  Google Scholar 

  11. Bauer J, Werner C, Gerss J (2009) Metabolic rate analysis of healthy preterm and full-term infants during the first weeks of life. Am J Clin Nutr 90:1517–1524

    Article  PubMed  CAS  Google Scholar 

  12. Riedijk MA, Voortman G, van Beek RH, Baartmans MG, Wafelman LS, van Goudoever JB (2008) Cyst(e)ine requirements in enterally fed very low birth weight preterm infants. Pediatrics 121:e561–567

    Article  PubMed  Google Scholar 

  13. Thomas B, Gruca LL, Bennett C, Parimi PS, Hanson RW, Kalhan SC (2008) Metabolism of methionine in the newborn infant: response to the parenteral and enteral administration of nutrients. Pediatr Res 64:381–386

    Article  PubMed  CAS  Google Scholar 

  14. Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R (2005) 3. Amino acids Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr 41(Suppl 2):12–18

    Google Scholar 

  15. Lemons JA, Adcock EW, 3rd, Jones MD Jr, Naughton MA, Meschia G, Battaglia FC (1976) Umbilical uptake of amino acids in the unstressed fetal lamb. J clin invest 58:1428–1434

    Article  PubMed  CAS  Google Scholar 

  16. van Veen LC, Teng C, Hay WW Jr, Meschia G, Battaglia FC (1987) Leucine disposal and oxidation rates in the fetal lamb. Metabolism 36:48–53

    Article  PubMed  Google Scholar 

  17. Chien PF, Smith K, Watt PW, Scrimgeour CM, Taylor DJ, Rennie MJ (1993) Protein turnover in the human fetus studied at term using stable isotope tracer amino acids. Am J Physiol 265:E31–35

    PubMed  CAS  Google Scholar 

  18. van den Akker CH, Schierbeek H, Minderman G et al (2011) Amino acid metabolism in the human fetus at term: leucine, valine, and methionine kinetics. Pediatr Res 70:566–571

    Article  Google Scholar 

  19. van den Akker CH, Schierbeek H, Dorst KY et al (2009) Human fetal amino acid metabolism at term gestation. Am J Clin Nutr 89:153–160

    Article  PubMed  Google Scholar 

  20. Ziegler EE, O’Donnell AM, Nelson SE, Fomon SJ (1976) Body composition of the reference fetus. Growth 40:329–341

    PubMed  CAS  Google Scholar 

  21. Dusick AM, Poindexter BB, Ehrenkranz RA, Lemons JA (2003) Growth failure in the preterm infant: can we catch up? Semin Perinatol 27:302–310

    Article  PubMed  Google Scholar 

  22. Denne SC, Poindexter BB (2007) Evidence supporting early nutritional support with parenteral amino acid infusion. Semin Perinatol 31:56–60

    Article  PubMed  Google Scholar 

  23. Shohl AT, Butler AM, Blackfan KD, MacLachlan E (1939) Nitrogen metabolism during the oral and parenteral administration of the amino acids of hydrolyzed casein. J Pediatr 15:469

    Article  CAS  Google Scholar 

  24. Helfrick FW, Abelson NM (1944) Intravenous feeding of a complete diet in a child: report of a case. J Pediatr 25:400–403

    Article  Google Scholar 

  25. Johnson JD, Albritton WL, Sunshine P (1972) Hyperammonemia accompanying parenteral nutrition in newborn infants. J Pediatr 81:154–161

    Article  PubMed  CAS  Google Scholar 

  26. Heird WC, Dell RB, Driscoll JM Jr, Grebin B, Winters RW (1972) Metabolic acidosis resulting from intravenous alimentation mixtures containing synthetic amino acids. New Engl J Med 287:943–948

    Article  PubMed  CAS  Google Scholar 

  27. Hay WW Jr (2008) Strategies for feeding the preterm infant. Neonatology 94:245–254

    Article  PubMed  Google Scholar 

  28. Saini J, MacMahon P, Morgan JB, Kovar IZ (1989) Early parenteral feeding of amino acids. Arch Dis Child 64:1362–1366

    Article  PubMed  CAS  Google Scholar 

  29. Yu VY, James B, Hendry P, MacMahon RA (1979) Total parenteral nutrition in very low birthweight infants: a controlled trial. Arch Dis Child 54:653–661

    Article  PubMed  CAS  Google Scholar 

  30. van Lingen RA, van Goudoever JB, Luijendijk IH, Wattimena JL, Sauer PJ (1992) Effects of early amino acid administration during total parenteral nutrition on protein metabolism in pre-term infants. Clin Sci (Lond) 82:199–203

    Google Scholar 

  31. Anderson TL, Muttart CR, Bieber MA, Nicholson JF, Heird WC (1979) A controlled trial of glucose versus glucose and amino acids in premature infants. J Pediatr 94:947–951

    Article  PubMed  CAS  Google Scholar 

  32. Rivera A Jr, Bell EF, Bier DM (1993) Effect of intravenous amino acids on protein metabolism of preterm infants during the first three days of life. Pediatr Res 33:106–111

    Article  PubMed  Google Scholar 

  33. Van Goudoever JB, Colen T, Wattimena JL, Huijmans JG, Carnielli VP, Sauer PJ (1995) Immediate commencement of amino acid supplementation in preterm infants:effect on serum amino acid concentrations and protein kinetics on the first day of life. J Pediatr 127:458–465

    Article  PubMed  CAS  Google Scholar 

  34. Thureen PJ, Anderson AH, Baron KA, Melara DL, Hay WW Jr, Fennessey PV (1998) Protein balance in the first week of life in ventilated neonates receiving parenteral nutrition. Am J Clin Nutr 68:1128–1135

    PubMed  CAS  Google Scholar 

  35. Ibrahim HM, Jeroudi MA, Baier RJ, Dhanireddy R, Krouskop RW (2004) Aggressive early total parental nutrition in low-birth-weight infants. J Perinat 24:482–486

    Article  Google Scholar 

  36. te Braake FW, van den Akker CH, Wattimena DJ, Huijmans JG, van Goudoever JB (2005) Amino acid administration to premature infants directly after birth. J Pediatr 147:457–461

    Article  PubMed  CAS  Google Scholar 

  37. Thureen PJ, Melara D, Fennessey PV, Hay WW Jr (2003) Effect of low versus high intravenous amino acid intake on very low birth weight infants in the early neonatal period. Pediatr Res 53:24–32

    Article  PubMed  CAS  Google Scholar 

  38. Clark RH, Chace DH, Spitzer AR (2007) Effects of two different doses of amino acid supplementation on growth and blood amino acid levels in premature neonates admitted to the neonatal intensive care unit: a randomized, controlled trial. Pediatrics 120:1286–1296

    Article  PubMed  Google Scholar 

  39. Blanco CL, Falck A, Green BK, Cornell JE, Gong AK (2008) Metabolic responses to early and high protein supplementation in a randomized trial evaluating the prevention of hyperkalemia in extremely low birth weight infants. J Pediatr 153:535–540

    Article  PubMed  CAS  Google Scholar 

  40. Kashyap S, Abildskov K, Holleran SF, Ramakrishnan R, Towers HM, Sahni R (2007) Effects of early aggressive nutrition in infants with birth weight (BW) < 1250 g: a randomized controlled trial. PAS (abstract) E-PAS2007:5912.2002

    Google Scholar 

  41. Roberts SA, Ball RO, Moore AM, Filler RM, Pencharz PB (2001) The effect of graded intake of glycyl-L-tyrosine on phenylalanine and tyrosine metabolism in parenterally fed neonates with an estimation of tyrosine requirement. Pediatr Res 49:111–119

    Article  PubMed  CAS  Google Scholar 

  42. Thureen PJ, Hay WW Jr (2001) Early aggressive nutrition in preterm infants. Semin Neonatol 6:403–415

    Article  PubMed  CAS  Google Scholar 

  43. Kashyap S (2008) Is the early and aggressive administration of protein to very low birth weight infants safe and efficacious? Curr Opin Pediatr 20:132–136

    Article  PubMed  Google Scholar 

  44. Ridout E, Melara D, Rottinghaus S, Thureen PJ (2005) Blood urea nitrogen concentration as a marker of amino-acid intolerance in neonates with birthweight less than 1,250 g. J Perinatol 25:130–133

    Article  PubMed  CAS  Google Scholar 

  45. Kotsopoulos K, Benadiba-Torch A, Cuddy A, Shah PS (2006) Safety and efficacy of early amino acids in preterm preterm < 28 weeks gestation: prospective observational comparison. J Perinatol 26:749–754

    Article  PubMed  CAS  Google Scholar 

  46. Radmacher PG, Lewis SL, Adamkin DH (2009) Early amino acids and the metabolic response of ELBW infants (≤ 1,000 g) in three time periods. J Perinatol 29:433–437

    Article  PubMed  CAS  Google Scholar 

  47. Balakrishnan M, Tucker R, Stephens BE, Bliss JM (2011) Blood urea nitrogen and serum bicarbonate in extremely low birth weight infants receiving higher protein intake in the first week after birth. J Perinatol 31:535–539

    Article  PubMed  CAS  Google Scholar 

  48. Roggero P, Gianni ML, Morlacchi L et al (2010) Blood urea nitrogen concentrations in low-birth-weight preterm infants during parenteral and enteral nutrition. J Pediatr Gastroenterol Nutr 51:213–215

    Article  PubMed  CAS  Google Scholar 

  49. Rosenthal P (1997) Assessing liver function and hyperbilirubinemia in the newborn. National Academy of Clinical Biochemistry. Clin Chem 43:228–234

    PubMed  CAS  Google Scholar 

  50. Usmani SS, Cavaliere T, Casatelli J, Harper RG (1993) Plasma ammonia levels in very low birth weight preterm infants. J Pediatr 123:797–800

    Article  PubMed  CAS  Google Scholar 

  51. American Academy of Pediatrics Committee on Nutrition (1985) Nutritional needs of low-birth-weight infants. Pediatrics 75:976–986

    Google Scholar 

  52. Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R (2005) 1. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr 41(Suppl 2):S1–S87

    Article  PubMed  Google Scholar 

  53. Vogt RA, Gargus RA, Tucker R, McKinley L, Vohr BR (2004) Impact of early postnatal nutrition on growth in extremely low birth weight infants born small for gestational age. PAS PAS2004:2525

    Google Scholar 

  54. Geary CA, Fonseca RA, Caskey MA, Malloy MH (2008) Improved growth and decreased morbidities in < 1,000 g neonates after early management changes. J Perinatol 28:347–353

    Article  PubMed  CAS  Google Scholar 

  55. Wilson DC, Cairns P, Halliday HL, Reid M, McClure G, Dodge JA (1987) Randomised controlled trial of an aggressive nutritional regimen in sick very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 77:F4–F11

    Article  Google Scholar 

  56. Blanco CL, Gong AK, Schoolfield J et al (2012) Impact of early and high amino acid supplementation on ELBW infants at 2 years. J Pediatr Gastroenterol Nutr 54:601–607

    Article  PubMed  CAS  Google Scholar 

  57. van den Akker CH, te Braake FW, Schierbeek H et al (2007) Albumin synthesis in premature neonates is stimulated by parenterally administered amino acids during the first days of life. Am J Clin Nutr 86:1003–1008

    Google Scholar 

  58. van den Akker CH, Schierbeek H, Rietveld T et al (2008) Human fetal albumin synthesis rates during different periods of gestation. Am J Clin Nutr 88:997–1003

    Google Scholar 

  59. Te Braake FW, Schierbeek H, de Groof K et al (2008) Glutathione synthesis rates after amino acid administration directly after birth in preterm infants. Am J Clin Nutr 88:333–339

    PubMed  CAS  Google Scholar 

  60. Soto-Moyano R, Fernandez V, Sanhueza M et al (1999) Effects of mild protein prenatal malnutrition and subsequent postnatal nutritional rehabilitation on noradrenaline release and neuronal density in the rat occipital cortex. Brain Res Dev Brain Res 116:51–58

    Article  PubMed  CAS  Google Scholar 

  61. Winick M, Rosso P (1969) The effect of severe early malnutrition on cellular growth of human brain. Pediatr Res 3:181–184

    Article  PubMed  CAS  Google Scholar 

  62. Morgane PJ, Mokler DJ, Galler JR (2002) Effects of prenatal protein malnutrition on the hippocampal formation. Neurosci Biobehav Rev 26:471–483

    Article  PubMed  CAS  Google Scholar 

  63. Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK (2006) Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 117:1253–1261

    Article  PubMed  Google Scholar 

  64. Latal-Hajnal B, von Siebenthal K, Kovari H, Bucher HU, Largo RH (2003) Postnatal growth in VLBW infants: significant association with neurodevelopmental outcome. J Pediatr 143:163–170

    PubMed  Google Scholar 

  65. Franz AR, Pohlandt F, Bode H et al (2009) Intrauterine, early neonatal, and postdischarge growth and neurodevelopmental outcome at 5.4 years in extremely preterm infants after intensive neonatal nutritional support. Pediatrics 123:e101–109

    Article  PubMed  Google Scholar 

  66. Kan E, Roberts G, Anderson PJ, Doyle LW (2008) The association of growth impairment with neurodevelopmental outcome at eight years of age in very preterm children. Early Hum Dev 84:409–416

    Article  PubMed  Google Scholar 

  67. Belfort MB, Rifas-Shiman SL, Sullivan T et al (2011) Infant growth before and after term: effects on neurodevelopment in preterm infants. Pediatrics 128:e899–906

    Article  PubMed  Google Scholar 

  68. Lucas A, Morley R, Cole TJ et al (1990) Early diet in preterm babies and developmental status at 18 months. Lancet 335:1477–1481

    Article  PubMed  CAS  Google Scholar 

  69. Lucas A, Morley R, Cole TJ (1998) Randomised trial of early diet in preterm babies and later intelligence quotient. BMJ 317:1481–1487

    Article  PubMed  CAS  Google Scholar 

  70. Isaacs EB, Gadian DG, Sabatini S et al (2008) The effect of early human diet on caudate volumes and IQ. Pediatr Res 63:308–314

    Article  PubMed  Google Scholar 

  71. Isaacs EB, Morley R, Lucas A (2009) Early diet and general cognitive outcome at adolescence in children born at or below 30 weeks gestation. J Pediatr 155:229–234

    Article  PubMed  Google Scholar 

  72. Tan M, Abernethy L, Cooke R (2008) Improving head growth in preterm infants—a randomised controlled trial II: MRI and developmental outcomes in the first year. Arch Dis Child Fetal Neonatal Ed 93:F342–F346

    Article  PubMed  CAS  Google Scholar 

  73. Dabydeen L, Thomas JE, Aston TJ, Hartley H, Sinha SK, Eyre JA (2008) High-energy and -protein diet increases brain and corticospinal tract growth in term and preterm infants after perinatal brain injury. Pediatrics 121:148–156

    Article  PubMed  Google Scholar 

  74. Poindexter BB, Langer JC, Dusick AM, Ehrenkranz RA (2006) Early provision of parenteral amino acids in extremely low birth weight infants: relation to growth and neurodevelopmental outcome. J Pediatr 148:300–305

    Article  PubMed  CAS  Google Scholar 

  75. Ehrenkranz RA (2007) Early, aggressive nutritional management for very low birth weight infants: what is the evidence? Semin Perinatol 31:48–55

    Article  PubMed  Google Scholar 

  76. Simmer K (2007) Aggressive nutrition for preterm infants—benefits and risks. Early Hum Dev 83:631–634

    Article  PubMed  CAS  Google Scholar 

  77. Hans DM, Pylipow M, Long JD, Thureen PJ, Georgieff MK (2009) Nutritional practices in the neonatal intensive care unit: analysis of a 2006 neonatal nutrition survey. Pediatrics 123:51–57

    Article  PubMed  Google Scholar 

  78. Collins CT, Chua MC, Rajadurai VS et al (2010) Higher protein and energy intake is associated with increased weight gain in pre-term infants. J Paediatr Child Health 46:96–102

    Article  PubMed  Google Scholar 

  79. Lapillonne A, Fellous L, Mokthari M, Kermorvant-Duchemin E (2009) Parenteral nutrition objectives for very low birth weight infants: results of a national survey. J Pediatr Gastr Nutr 48:618–626

    Article  Google Scholar 

  80. Grover A, Khashu M, Mukherjee A, Kairamkonda V (2008) Iatrogenic malnutrition in neonatal intensive care units: urgent need to modify practice. JPEN J Parenter Enteral Nutr 32:140–144

    Article  PubMed  CAS  Google Scholar 

  81. Hopewell J, Miletin J (2012) Parenteral nutrition in very low birth weight infants in the United Kingdom and Ireland. Ir Med J 105:42–45

    PubMed  CAS  Google Scholar 

  82. Kirk EL (2009) Audit to determine whether current parenteral nutrition regimens for pre-term infants on the neonatal unit are in accordance with international guidelines. Arch Dis Child 94:e2

    Google Scholar 

  83. Taveras EM, Rifas-Shiman SL, Belfort MB, Kleinman KP, Oken E, Gillman MW (2009) Weight status in the first 6 months of life and obesity at 3 years of age. Pediatrics 123:1177–1183

    Article  PubMed  Google Scholar 

  84. Belfort MB, Rifas-Shiman SL, Rich-Edwards J, Kleinman KP, Gillman MW (2007) Size at birth, infant growth, and blood pressure at three years of age. J Pediatr 151:670–674

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, Erasmus MC—Sophia Children’s Hospital, Rotterdam, The Netherlands

    Hester Vlaardingerbroek MD

  2. Department of Pediatrics, Emma Children’s Hospital—AMC, Amsterdam, The Netherlands

    Johannes B. van Goudoever MD, PhD

  3. Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands

    Johannes B. van Goudoever MD, PhD

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  1. Hester Vlaardingerbroek MD
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  2. Johannes B. van Goudoever MD, PhD
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Correspondence to Hester Vlaardingerbroek MD .

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  1. , Neonatal Paediatrics, KEM Hospital for Women, Bagot Road 374, Perth, 6008, West Australia, Australia

    Sanjay Patole

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Vlaardingerbroek, H., van Goudoever, J. (2013). Amino Acids. In: Patole, S. (eds) Nutrition for the Preterm Neonate. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6812-3_12

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