Impact of Parenteral Amino Acid Intake on Electrolytes Levels Among Preterm Infants: A Retrospective Study

Main Article Content

Abdurahman Alatawi , Ibrahim Alatwi , Mashari M Alrayees , Fatimah A. Alharthi , Khaled R. A. Abdellatif

Keywords

Parenteral amino acid, Preterm infants, Electrolytes level

Abstract

Parenteral nutrition (PN) is recommended for premature babies weighing less than 1500 g. The administration of high doses of amino acids (AA) immediately after birth is recommended to maintain adequate premature growth and development. However, some studies have suggested that such high AA doses can cause electrolyte imbalance. Therefore, the aim of this study is to identify the correlation between daily AA intake and relative serum electrolyte levels. A retrospective cross-sectional study was conducted comparing two groups of preterm infants born before 34 weeks gestation with birth weights of less than 1500 g managed with PN. 214 infants’ records were included in the study: 121 were administered with less than 3 g/kg/day of AA (low-intake group) and 93 were administered at least 3 g/kg/day (high-intake group) throughout seven consecutive days. Serum sodium level was found to be normal in both groups; however, the mean value of patients received ≥ 3 g AA was higher than the patients receiving < 3g AA and this difference was statistically significant (p=0.011). The mean values of serum chloride, phosphate, potassium, magnesium, and calcium have no statistically significant difference between the two groups. Hyperchloremia and hypophosphatemia were observed in both groups. Hypermagnesemia and hypercalcemia were observed in patients receiving < 3 g AA. Thus, there was no association between electrolyte imbalance and the AA dose delivered by PN in the high-intake group of preterm infants.

Abstract 183 | PDF Downloads 55

References

1. Ditsch, N., Wöcke, A., Untch, M., Jackisch, C., Albert, U.S., Banys-Paluchowski, M., Bauerfeind, I., Blohmer, J.U., Budach, W., Dall, P. and Fallenberg, E.M., AGO recommendations for the diagnosis and treatment of patients with early breast cancer: update,BreastCare,2022,17:403 https://doi.org/10.1159/000524879
2. Gilmore, J.H., Shi, F., Woolson, S.L., Knickmeyer, R.C., Short, S.J., Lin, W., Zhu, H., Hamer, R.M., Styner, M. and Shen, D., Longitudinal development of cortical and subcortical gray matter from birth to 2 years, Cerebral cortex, 2012, 22:2478 https://doi.org/10.1093/cercor/bhr327
3. Elstgeest, L.E., Martens, S.E., Lopriore, E., Walther, F.J. and te Pas, A.B., Does parenteral nutrition influence electrolyte and fluid balance in preterm infants in the first days after birth? PLoS One, 2010,5:e9033https://doi.org/10.1371/journal.pone.0009033
4. Al-Salem A.H. Nutrition for Infants and Children. In: Atlas of Pediatric Surgery, Springer, Cham, 2020, 27:39 https://doi.org/10.47338/jns.v11.1034
5. Silveira RC, Corso AL, Procianoy RS. The Influence of Early Nutrition on Neurodevelopmental Outcomes in Preterm Infants. Nutrients. 2023 Nov 1;15(21):4644.https://doi.org/10.3390/nu15214644
6. Boscarino G, Carducci C, Conti MG, Podagrosi M, Gigliello A, Di Chiara M, Bartolucci M, Brunelli R, Parisi P, Angeloni A, Terrin G. Early Energy Intake and Amino Acid Profile in Preterm Newborns: A Quasi-Experimental Study. Nutrients. 2023 Jun 27;15(13):2917.https://doi.org/10.3390/nu15132917
7. Georgieff, M.K., Nutrition and the developing brain: nutrient priorities and measurement, The American journal of clinical nutrition, 2007, 85:614Shttps://doi.org/10.1016/j.clnu.2018.06.950
8. https://www.who.int/newsroom/factsheets/detail/preterm-birth Retrieved 1st December 2021
9. Agostoni, C., Buonocore, G., Carnielli, V.P., De Curtis, M., Darmaun, D., Decsi, T., Domellöf, M., Embleton, N.D., Fusch, C., Genzel-Boroviczeny, O. and Goulet, O., Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition, Journal of pediatric gastroenterology and nutrition, 2010,50:85 https://doi.org/10.1097/MPG.0b013e3181adaee0
10. Moltu, S.J., Blakstad, E.W., Strømmen, K., Almaas, A.N., Nakstad, B., Rønnestad, A., Brække, K., Veierød, M.B., Drevon, C.A., Iversen, P.O. and Westerberg, A.C., Enhanced feeding and diminished postnatal growth failure in very-low-birth-weight infants, Journal of pediatric gastroenterology and nutrition, 2014, 58:344 https://doi.org/10.1097/MPG.0000000000000220
11. Parramón-Teixidó, C.J., Gómez-Ganda, L., Garcia-Palop, B., Linés-Palazón, M., Blanco-Grau, A., Montoro-Ronsano, J.B. and Clemente-Bautista, S., The influence of parenteral protein intake on electrolyte disturbances in premature infants, Anales de Pediatría (English Edition), 2021, 95:139 https://doi.org/10.1016/j.anpede.2020.10.001
12. Fenton TR, Al-Wassia H, Premji SS, Sauve RS. Higher versus lower protein intake in formula‐fed low birth weight infants. Cochrane database of systematic reviews. 2020(6).https://doi.org/10.1002/14651858.CD003959.pub4
13. Sung, S.I., Chang, Y.S., Choi, J.H., Ho, Y., Kim, J., Ahn, S.Y. and Park, W.S., Increased risk of refeeding syndrome–like hypophosphatemia with high initial amino acid intake in small-for-gestational-age, extremely-low-birthweight infants, PLoS One, 2019, 14:e0221042 https://doi.org/10.1371/journal.pone.0221042
14. van Goudoever, J., 3 ESPGHAN/ESPEN/ESPR Guidelines on pediatric parenteral nutrition: Amino acids, 2018 https://doi.org/10.1016/j.clnu.2018.06.945
15. Osborn, D.A., Schindler, T., Jones, L.J., Sinn, J.K. and Bolisetty, S., Higher versus lower amino acid intake in parenteral nutrition for newborn infants, Cochrane Database of Systematic Reviews, 2018 https://doi.org/10.1002/14651858.CD005949.pub2
16. Yannan, J. and ProVIDe Trial Group, Neonatal Refeeding Syndrome and Clinical Outcome in Extremely Low-Birth-Weight Babies: Secondary Cohort Analysis From the ProVIDe Trial, 2020.
17. Balakrishnan, M., Jennings, A., Przystac, L., Phornphutkul, C., Tucker, R., Vohr, B., Stephens, B.E. and Bliss, J.M., Growth and neurodevelopmental outcomes of early, high‐dose parenteral amino acid intake in very low birth weight infants: a randomized controlled trial, Journal of Parenteral and Enteral Nutrition, 2018, 42:597 https://doi.org/10.1177/0148607117696330
18. Leenders, E.K., de Waard, M. and van Goudoever, J.B., Low-versus high-dose and early versus late parenteral amino-acid administration in very-low-birth-weight infants: a systematic review and meta-analysis, Neonatology, 2018, 113:187 https://doi.org/10.1159/000481192
19. Koletzko, B., Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), supported by the European Society of Paediatric Research (ESPR). 2: Energy, J Pediatr Gastroenterol Nutr, 2005, 41:S5 https://doi.org/10.1159/000481192
20. Spady, D.W., Schiff, D. and Szymanski, W.A., A description of the changing body composition of the growing premature infant, Journal of pediatric gastroenterology and nutrition, 1987, 6:730 DOI: 10.1097/00005176-198709000-00013
21. Darmaun, D., Lapillonne, A., Simeoni, U., Picaud, J.C., Rozé, J.C., Saliba, E., Bocquet, A., Chouraqui, J.P., Dupont, C., Feillet, F. and Frelut, M.L., Parenteral nutrition for preterm infants: Issues and strategy, Archives de Pédiatrie, 2018, 25:286 https://doi.org/10.1016/j.arcped.2018.02.005
22. Segar, J.L., A physiological approach to fluid and electrolyte management of the preterm infant, Journal of Neonatal-Perinatal Medicine, 2020, 13:11 DOI: 10.3233/NPM-190309
23. Igarashi, A., Okuno, T., Ohta, G., Tokuriki, S. and Ohshima, Y., Risk factors for the development of refeeding syndrome-like hypophosphatemia in very low birth weight infants, Disease markers, 2017 https://doi.org/10.1155/2017/9748031
24. Senterre, T., Zahirah, I.A., Pieltain, C., de Halleux, V. and Rigo, J., Electrolyte and mineral homeostasis after optimizing early macronutrient intakes in VLBW infants on parenteral nutrition, Journal of Pediatric Gastroenterology and Nutrition, 2015, 61:491 DOI: 10.1097/MPG.0000000000000854
25. Mulla, S., Stirling, S., Cowey, S., Close, R., Pullan, S., Howe, R., Radbone, L. and Clarke, P., Severe hypercalcaemia and hypophosphataemia with an optimised preterm parenteral nutrition formulation in two epochs of differing phosphate supplementation, Archives of Disease in Childhood-Fetal and Neonatal Edition, 2017, 102: F451 http://dx.doi.org/10.1136/archdischild-2016-311107
26. Brener Dik, P.H., Galletti, M.F., Fernández Jonusas, S.A., Alonso, G., Mariani, G.L. and Fustinana, C.A., Early hypophosphatemia in preterm infants receiving aggressive parenteral nutrition, Journal of Perinatology,2015,35:712 https://doi.org/10.1038/jp.2015.54
27. Mizumoto, H., Mikami, M., Oda, H. and Hata, D., Refeeding syndrome in a small‐for‐dates micro‐preemie receiving early parenteral nutrition, Pediatrics International, 2012, 54:715 https://doi.org/10.1111/j.1442-200X.2012.03590.x
28. Czech-Kowalska, J., Mineral and nutritional requirements of preterm infant, In Seminars in Fetal and Neonatal Medicine (Vol. 25, No. 1, p. 101071), 2020, WB Saunders https://doi.org/10.1016/j.siny.2019.101071
29. Mihatsch, W., Fewtrell, M., Goulet, O., Molgaard, C., Picaud, J.C., Senterre, T., Braegger, C., Bronsky, J., Cai, W., Campoy, C. and Carnielli, V., ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: calcium, phosphorus and magnesium, Clinical Nutrition, 2018, 37:2360 https://doi.org/10.1016/j.clnu.2018.06.950