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ABSTRACT. Background: Aggressive parenteral nutrition (PN) including amino acids is recommended for low-birth-weight infante to prevent energy and protein deficit. Their impact on acid-base homeostasis has not been examined. Methods: We investigated the impact of dose and duration of parenteral amino acids, with cysteine, on acid-base parameters in 122 low-birth-weight infants. Premature infants ≤32 weeks, ≤1850 g, and receiving parenteral amino acids at 1.5 g/kg/d for an extended period (>24 hours), or 3 g/kg/d for a short (5 hour), extended (24 hour), or prolonged (3-5 days) duration were included in the study. Data were obtained at age 0-3 days (n = 43) or, when clinically stable, age 3-5 days (n = 49). Data from 30 infants, matched for birth weight and gestational age, receiving PN during the first 5 days after birth were also obtained. Acidosis was defined as pH <7.25. Results: Acidosis was evident in all infants between 2 and 5 days after birth. Infants with large patent ductus arteriosus (PDA) exhibited significantly (p < .05) lower pH early, had higher blood urea nitrogen levels (26 ± 9 vs 18 + 8 mg/dL; p < .05), and had greater weight lose (~17% of birth weight) when compared with infants without PDA. Gestational age, weight loss, and patent ductus arteriosus accounted for 65% of variance in acidosis. Conclusions: Low-birth-weight infants develop metabolic acidosis between 2 and 5 days after birth, irrespective of dose and duration of parenteral amino acid administration. Careful management of parenteral fluids and comorbidities may lower the incidence of acidosis and promote protein accretion. (Journal of Parenteral and Enteral Nutrition 31:278-283, 2007)
Low-birth-weight infants, although born appropriate for gestational age, consistently show postnatal growth restriction.1-8 Postnatal growth failure in premature infants has been attributed to protein and energy deficits accruing over the duration of the hospital stay.4 Therefore, greater emphasis has been placed on early aggressive nutrition care of these infants in order to prevent postnatal growth retardation. A number of investigators have suggested that parenteral nutrition (PN) should be initiated as early after birth as possible and that parenteral amino acids be administered at 3-3.5 g/kg/d in order to mimic protein accretion during fetal life. Only a few studies have examined the safety of early and aggressive administration of parenteral...