Abstract
Objective: Very-low-birth-weight (VLBW) preterm infants are at risk of growth delay if they do not receive adequate nutritional support. This study evaluated the effect of aggressive early high-dose amino acid infusion plus early enteral trophic feeding on growth in VLBW infants within the first day of life. Study Design: The effect of a high-dose 3 g amino acid (HAA)/kg/d regimen beginning on the first day of life was compared with that of low-dose amino acid (LAA) supplementation at a dose of 0.5 or 1.0 g/kg/d. The primary outcome measures were the days of regained birth weight and achieved full enteral feeding. Result: Compared with the 19 infants in the LAA group, the 17 infants in the HAA group achieved significantly earlier full enteral feeding (7.8 ± 3.6 vs. 15.2 ± 8.9, p = 0.003) and regained birth weight (13.3 ± 3.8 vs. 17.5 ± 7.9, p = 0.047). In addition, shorter parenteral nutrition time was achieved by HAA administration (p < 0.05). Total energy intake was greater during the first 7 days of life in the HAA group (85 ± 12 kcal/kg/d on day 7) than in the LAA group (60 ± 16 kcal/kg/d on day 7, p < 0.001). Other clinical parameters such as length of hospital stay and morbidity favored the use of HAA. Conclusion: Aggressive early simultaneous amino acid administration plus enteral feeding during the first few days of life for preterm infants was associated with improved weight gain and earlier full enteral feeding.
Highlights
Very-low-birth-weight (VLBW) infants are born at a time of rapid intrauterine brain and body growth [1]
This study evaluated the effect of aggressive early high-dose amino acid infusion plus early enteral trophic feeding on growth in VLBW infants within the first day of life
The preterm infants in the low-dose amino acid (LAA) group were started on amino acids (Aminosteril Infant Fresenius Kabi, Germany) at 0.5 or 1.0 g/kg/d on day 1, which was increased to a maximum of 2.0 g/kg/d as a maintenance dose
Summary
Very-low-birth-weight (VLBW) infants are born at a time of rapid intrauterine brain and body growth [1] These infants have limited endogenous energy stores and depend on administering nutrients in postnatal life. Insufficient protein or amino acid administration may worsen the respiratory distress syndrome (RDS), cause growth delay, or increase morbidity in VLBW infants [3,4,5,6,7] It is common practice for preterm infants requiring nutritional support to be gradually started on amino acid infusion between 0 and 36 hours after birth. This study evaluated the effect of highly first dose amino acid infusion (3 g/kg/d) administered during the first 24 hours of life in VLBW infants and compared it with that of lowly first dose early amino acid infusion (
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