1 Division of Neonatology University of Miami (R-131) School of Medicine Miami, FL 33101
2 Division of Neonatology University of Southern California Medical Center Los Angeles, CA 90033
We agree with Dr Procianoy's suggestion that high caloric solutions may ameliorate the hyperammonemia accompanying asphyxia. However, we would like to stress that hyperammonemia secondary to perinatal asphyxia most likely begins in utero and results from an increase in protein breakdown,1 and hepatic damage secondary to ischemia. It is unlikely that early high caloric intake will suppress this elevation although it might attenuate it. We have recently noted hyperammonemia in asphyxiated neonates within 15 minutes of birth.