Purpose To compare metabolic and physiologic responses of extremely low birth weight (ELBW: # 1,000 g) neonates to early (# 24 hours.) or later (> 24 hr) initiation of intravenous amino acids (iAA) with glucose in the first 6 days of life.
Methods This study received IRB approval prior to initiation. Infants were born between 1/1/2000 and 12/31/01. In addition to BW # 1,000 g, eligibility criteria included admission to the Kosair Children's Hospital NICU within 24 hours of birth, survival $ 7 days, and lack of major congenital anomalies. Data were collected retrospectively from infant medical charts. Cohorts were initially constructed based on initiation of iAA before or after 24 hours of life. Additionally, data were analyzed in 2 BW cohorts (# 750 g and 751-1,000 g) to study effects related to developmental immaturity. Statistical analysis was conducted with SPSS version 11.5. Statistical significance was set at p < .05.
Results There were 70 infants in the final data set. The proportion of infants who were small for gestational age (SGA: BW < 10th percentile for GA) was similar for iAA groups and BW cohorts. Mean time to iAA for the early group (n = 40) was 6.1 6 5.8 hours compared to 44.1 6 16.8 for the later group (n = 30). Mean serum blood urea nitrogen (BUN), potassium (K), and glucose (GLC) concentrations were within acceptable ranges regardless of age at iAA or BW cohort. Statistically significant differences in lab values that did occur between groups were not clinically important. There was significantly less postnatal weight loss (PWL) in infants receiving early iAA both by actual grams (9.7 6 15.7 vs 17.0 6 11.8; p = .036) and by proportion (12.3 6 7.3% vs 16.1 6 7.7%; p = .039). There was no difference in PWL based on BW. There were no differences in the time to return to birth weight (RTBW) based on iAA group or BW cohort. There was no correlation between AA intake and serum BUN at any time in the first 6 days of life.
Conclusions Intravenous AA can be safely used in very critically ill, immature neonates in the first hours of life. Early iAA can reduce loss of lean body mass.
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