By Linda M. Charles
TORONTO, CANADA -- May 11, 2007 -- Early administration of amino acids in preterm infants is safe, but its long-term efficacy remains to be studied, according to research presented here at the annual meeting of the Pediatric Academic Societies (PAS).
Previous studies demonstrated a benefit in early administration of amino acids to neonates, explained Prakeshkumar S. Shah, MD, assistant professor, department of paediatrics, University of Toronto, and staff neonatologist, department of paediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
To lend evidence to a change in practice from late to early administration of amino acids in neonates at his institution, Dr. Shah and colleagues compared the effects of immediate administration of amino acids compared with delayed administration in infants whose gestational age was 28 weeks.
The goal of the earlier delivery of amino acids is to curb postnatal growth restriction, a phenomenon that is virtually universal in preterm infants, Dr. Shah said in his presentation on May 6th.
The investigators first analysed patient records dating from March 2003 to March 2004, of 54 infants who received IV infusions at 1.0 kg/day of amino acids and 0.5-1.0 g/kg/day of 20% intra-lipid at 12 to 30 hours after birth. Investigators then compared records of 54 infants who were treated at the hospital between April 2004 and April 2005. These infants were given a 2% amino acid solution containing 10% dextrose that was started at 80 cc/kg/day, providing 1.4-1.6 g/kg/day within the first six hours of birth, with subsequent administration of lipids at a similar time range to infants who received amino acids later in life.
The rate of advancement for amino acids and lipids, respectively, were 1.0 g/kg/day to a maximum of 3.5-4.0 g/kg/day for amino acids and 3 g/kg/day for lipids for all infants studied.
A total of nine infants who received amino acids early were lost to follow up, and two died during follow up. Amongst infants whose parenteral delivery of amino acids was delayed, 21 were lost to follow up and three died.
The difference between the time of initiation of parenteral nutrition was statistically significant (4 hours vs 20 hours, P <.001).
Infants who received amino acids earlier regained their weight more quickly than those who received them later (11days vs 13 days, P =.05). Fewer infants who got early administration of amino acids fell below the 10th percentile at 32 weeks (43% vs 65%, P =.03).
There was less late-onset sepsis in infants who got early parenteral nutrition (30% vs. 56%, P =.01). There were no significant differences in growth rate, head circumference, or secondary outcomes between the two study arms.
Longer-term monitoring of the neonates is necessary to assess if there are significant differences in safety and efficacy between early and late administration of amino acids.
The ideal follow up would be to study at a later stage the infants in this study who received early administration of amino acids, Dr. Shah said.
The study was independently conducted.
[Presentation title: Growth and Neurodevelopmental Outcomes of Infants who Received Amino Acid Administration Immediately After Birth. Abstract 6280.18]
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