Published online October 12, 2009
PEDIATRICS Vol. 124 No. 5 November 2009, pp. e978-e984 (doi:10.1542/peds.2008-2477)
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ARTICLE

High-Dose Cysteine Administration Does Not Increase Synthesis of the Antioxidant Glutathione Preterm Infants

Frans W.J. te Braake, PhDa, Henk Schierbeek, BSca, Andras Vermes, PharmD, PhDb, Jan G.M. Huijmans, PhDc and Johannes B. van Goudoever, MD, PhDa

a Department of Pediatrics, Division of Neonatology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands; and Departments of
b Clinical Pharmacy
c Clinical Genetics, Erasmus Medical Center, Rotterdam, Netherlands

OBJECTIVE: Our aim was to evaluate whether administration of additional cysteine is safe and stimulates glutathione synthesis in preterm infants in early life.

METHODS: We conducted a prospective, randomized, clinical trial with infants with birth weights of <1500 g (N = 20). The infants were assigned randomly to receive either a standard dose (45 mg/kg per day) or a high dose (81 mg/kg per day) of cysteine. Intakes of other amino acids were similar, providing a total protein intake of 2.4 g/kg per day in both groups. We recorded base requirements in the first 6 days of life. On postnatal day 2, we conducted a stable isotope study to determine glutathione concentrations and synthesis rates in erythrocytes.

RESULTS: Base requirements were higher in the high-dose cysteine group on days 3, 4, and 5. Despite an 80% increase in cysteine intake, plasma cystine concentrations did not increase. Glutathione concentrations and synthesis rates did not increase with additional cysteine administration.

CONCLUSIONS: Administration of a high dose of cysteine (81 mg/kg per day) to preterm infants seems clinically safe but does not stimulate glutathione synthesis, compared with a lower dose (45 mg/kg per day). Further research is required to determine whether there is significant benefit associated with cysteine supplementation.

Key Words: glutathione • premature infants • neonatal intensive care unit • cysteine • parenteral nutrition • stable isotopes

Abbreviations: AA—amino acid • FSR—fractional synthesis rate • ASR—absolute synthesis rate

Accepted Jun 4, 2009.


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