PEDIATRICS Vol. 81 No. 1 January 1988, pp. 41-50
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Pediatric Parenteral Amino Acid Mixture in Low Birth Weight Infants

William C. Heird MD1, William Hay MD1, Richard A. Helms PharmD1, Michael C. Storm PhD1, Sudha Kashyap MD1, and Ralph B. Dell MD1

1 From the Departments of Pediatrics, Columbia University College of Physicians and Surgeons, New York; and University of Colorado School of Medicine, Denver; the Department of Clinical Pharmacy, University of Tennessee School of Medicine, Memphis; and the Research Department of Kendall McGaw Laboratories, Inc, Irvine, California

A mixture of amino acids designed to maintain normal plasma amino acid concentrations in infants and children requiring parenteral nutrition was evaluated in 28 low birth weight (LBW) infants (birth weight, 750 to 1750 g; postnatal age, 1 to 4 weeks) who required parenteral nutrients for optimal nutritional management. Sixteen babies received only parenteral nutrients for five to 21 days. Ten of these received a typical regimen by peripheral vein (1.91 ± 0.16 g/kg/d of amino acids and 44.7 ± 4.4 kcal/kg/d) and six received a typical regimen through a central vein (2.39 ± 0.11 g/kg/d of amino acids and 95.9 ± 14.5 kcal/kg/d). Mean weight gain of the peripheral vein subgroup was 10.3 ± 10.6 g/kg/d; mean nitrogen balance was 230 ± 66 mg/kg/d. Both the mean rate of weight gain (17.2 ± 5.1 g/kg/d) and the mean rate of nitrogen retention (267 ± 49 g/kg/d) of the central vein subgroup were similar to intrauterine rates. In these two subgroups as well as the total population, plasma concentrations of all amino acids except phenylalanine were within the 95% confidence limits of the plasma concentrations observed in LBW infants fed sufficient amounts of human milk to result in a rate of weight gain similar to the intrauterine rate. However, although plasma tyrosine and cyst(e)ine concentrations were within the 95% confidence limits of the plasma concentrations goals, the LBW infant's ability to use N-acetyl-l-tyrosine and cysteine HCl appears to be even less than that of the term infant and older child. In toto, these data support the efficacy of the amino acid mixture evaluated for LBW infants. Of equal importance, they suggest that the LBW infant's ability to use parenterally delivered amino acids is not as limited as commonly thought.

Key Words: parenteral nutrition • plasma amino acids • cyst(e)ine • N-acetyl-l-tyrosine • taurine • optimization technique • low birth weight infant

Submitted on January 29, 1987
Accepted on May 5, 1987




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