Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Nutritional strategy of early amino acid administration in very low birth weight infants

  • Lee, Byong Sop (Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2014.10.14
  • Accepted : 2015.02.16
  • Published : 2015.03.10
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Abstract

Relative to a fetus of the same gestational age, very low birth weight (VLBW) infants are more likely to be underfed and to undergo growth restriction during their early hospital stay. The current trend towards "early and aggressive" nutritional strategies in VLBW infants aims to overcome the early nutritional deficiency and thereby boost postnatal catch-up growth, simultaneously improving long-term neurodevelopmental outcomes. Although the minimum starting amino acid (AA) dose to prevent negative nitrogen balance is well established, the upper limit and the rate of increase of early AA doses are controversial. Most randomized controlled trials show that early and high-dose (target, 3.5 to 4.9 g/kg/day) AA regimens, with or without high nonprotein calories, do not improve long-term growth and neurodevelopment. High-dose AA supplementation may lead to early metabolic disturbances and excessive or disproportionate plasma AA levels, particularly in infants of very low gestational age. Further large studies are needed to clarify the optimal strategy for early administration of parenteral AA doses in VLBW infants.

Keywords

References

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