Impact of Early and High Amino Acid Supplementation on ELBW Infants at 2 Years

Blanco, Cynthia L.*; Gong, Alice K.*; Schoolfield, John; Green, Belinda K.; Daniels, Wanda*; Liechty, Edward A.§; Ramamurthy, Rajam*

Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e31824887a0
Original Articles: Hepatology and Nutrition
Abstract

Objective: The aim of the present study was to examine the effects of early and high intravenous (IV) amino acid (AA) supplementation on growth, health, and neurodevelopment of extremely-low-birth-weight (ELBW) infants throughout their first 2 years of life.

Methods: Infants were prospectively randomized in a double-masked fashion and treated for 7 days with either IV AA starting at 0.5 g · kg−1 · day−1 and increased by 0.5 g · kg−1 every day to 3 g · kg−1 · day−1 or starting at 2 g · kg−1 · day−1 of IV AA and advanced by 1 g · kg−1 every day to 4 g · kg−1 · day−1. Plasma AA concentrations were determined by reverse-phase high-performance liquid chromatography. Survivors were longitudinally assessed with Bayley II Scales of Infant Development and physical, social, and global health.

Results: Forty-three of 51 survivors were studied. Mental Developmental Index (MDI) and Psychomotor Developmental Index were similar between groups; however, the early and high AA group had a lower MDI at 18 months. This difference disappeared at 2 years of age. The early and high AA group z score means for weight, length, and head circumferences were significantly lower than the standard AA group at most visits. Cumulative and single plasma AA concentrations correlated negatively with MDI and postnatal growth.

Conclusions: ELBW infants who received early and high IV AA during the first week of life were associated with poor overall growth at 2 years.

Author Information

*Department of Pediatrics, University of Texas Health Science Center San Antonio

Department of Academic Technology Services, University of Texas Health Science Center San Antonio

Department of Pharmacy, University Health System, San Antonio; Pharmacotherapy Division, College of Pharmacy, University of Texas at Austin; Pharmacotherapy Education and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, TX

§Department of Pediatrics, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN.

Address correspondence and reprint requests to Cynthia L. Blanco, MD, Department of Pediatrics, University of Texas Health Science Center, 7703 Floyd Curl Dr, MSC 7812, San Antonio, TX 78229-3900 (e-mail: blanco@uthscsa.edu).

Received 26 September, 2011

Accepted 27 December, 2011

www.clinicaltrials.gov registration number: NCT00290160.

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN