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247 COMPARISON OF TWO EPOCHS AFTER A NEW PROTOCOL FOR EARLY AMINO ACIDS IN EXTREMELY LOW BIRTH WEIGHT INFANTS.
  1. J. Meyer1,
  2. P. Radmacher1,
  3. M. Adamkin1,
  4. D. Adamkin1
  1. 1Department of Pediatrics, University of Louisville, Louisville, KY

Abstract

Purpose To compare metabolic and physiologic responses of extremely low birth weight infants (ELBW: ≤ 1,000 g) from birth-DOL 5 in two periods after instituting a new TPN protocol. E-I was 1/1/00-12/31/01; E-II ran from 1/1/02-7/1/04. Early TPN was initiated within 24 hours of birth; later TPN was that begun after 24 hours of life.

Methods This was a retrospective chart review. Eligibility included weight, admission within 24 hours of birth, survival ≥ 7 days, and freedom from serious congenital anomalies. Data included basic demographics, daily nutritional intakes from all sources, and high and low values of specified laboratory tests. Significant medical events during remaining hospitalization were captured as well.

Results Seventy ELBW infants in E-I were compared with 99 in E-II. BW, GA, and illness scores were similar in both cohorts. Early TPN was more prevalent in E-II (74%) compared with E-I (55%) (p < .001); the age at initiation fell from 22.4 ± 22.3 hours (E-I) to 9.5 ± 12.3 hours (E-II) (p < .001). The proportion of infants with BW < 10th percentile for GA (small for GA: SGA) was similar (10% and 9%, respectively). At discharge, the proportion of infants with extrauterine growth restriction (EUGR: wt or HC for GA < 10th percentile) in E-II was reduced (66%) compared with E-I (82%), although not reaching statistical significance. Time to return to birth weight (RTBW) decreased from 14 ± 6 days (E-I) to 11 ± 6 days (E-II) (p = .001). Mean AA intake was significantly increased in E-II compared with E-I (1.8 ± 0.5 vs 1.2 ± 0.4 g/k/d; p < .001). Mortality was similar in both epochs (≈10%). In E-I, the proportion of infants with microcephaly (HC < 10%) at birth was 10% and increased to 15.7% at discharge. In E-II, 16% of infants were microcephalic at birth; at discharge, that proportion was 7%. Cholestasis (CHL: direct bilirubin > 2.2 mg/dL) rose from 11% in E-I to 26% in E-II (p = .02). Overall, the infants with CHL were smaller (679 g vs 791 g), more immature (25 wk vs 26 wk), sicker (SNAPPE 52 vs 36), reached RTBW sooner (9.7 d vs 12.6 d), and received more days of TPN (62 vs 24). During both epochs, overall metabolic response to early TPN was acceptable (glucose, K, BUN). There was no correlation between protein dose and BUN.

Conclusions The increased use of early amino acids has positively influenced postnatal growth performance by reducing RTBW and extrauterine growth restriction (EUGR) without metabolic stress. There was an increase in cholestasis.

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