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High-dose parenteral amino acid intake in very low birthweight infants

what is the current evidence?

Pillai, Anisha,b,c; Albersheim, Susana,b,c; Elango, Rajavela,b,c,d

Current Opinion in Clinical Nutrition & Metabolic Care: May 2019 - Volume 22 - Issue 3 - p 236–241
doi: 10.1097/MCO.0000000000000560
PAEDIATRICS: Edited by Berthold Koletzko and Raanan Shamir

Purpose of review There is uncertainty regarding optimal dosing for parenteral amino acids in preterm infants and wide variability exists in clinical practice. There is new data from clinical trials trying to address these concerns. We review the recent evidence on parenteral high-dose amino acid intake in very low birth weight (VLBW) neonates with a focus on relevant clinical outcomes.

Recent findings Preterm infants often receive less protein than intended in the first week of life. Parenteral amino acid administration in doses that exceed requirements, however, leads to increased oxidation and higher blood urea concentrations. Amino acid doses greater than 3.5 g/kg/day have not shown to improve mortality, neonatal morbidities including sepsis, necrotizing enterocolitis, chronic lung disease, growth parameters or neurodevelopmental outcomes at 2 years of age.

Summary Parenteral amino acid administration in VLBW infants should be initiated soon after birth at a dose of at least 1.5 g/kg/day to maintain anabolism. The maximum dose for parenteral amino acid should be between 2.5 and 3.5 g/kg/day, with adequate nonprotein calories and micronutrients to ensure efficient protein utilization and growth.

aNeonatal-Perinatal Medicine, BC Women's Hospital and Health Centre

bDepartment of Pediatrics, University of British Columbia

cBC Children's Hospital Research Institute

dSchool of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

Correspondence to Rajavel Elango, PhD, Rm170A, 950 West 28th Avenue, BC Children's Hospital Research Institute, Vancouver, BC, Canada V5Z 4H4. Tel: +1 604 875 2000 x4911; e-mail:

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