Effect of two different doses of parenteral amino acid supplementation on postnatal growth of very low birth weight neonates - A randomized controlled trial

To evaluate the effects of two different doses of parenteral aminoacid supplementation on postnatal growth in Very Low Birth Weight (VLBW) infants receiving partial parenteral nutrition (PPN). Double blinded randomized controlled trial. Level 3 NICU between February 2008 to February 2010. 150 inborn babies with birthweight between 900-1250 g, irrespective of gestational age, were randomized to either of the two interventions of amino acid supplementation. Two different initial doses of parenteral amino acids (AA) in the PPN solutions- Low AA group: 1 g/kg/d versus High AA group: 3 g/kg/d from day 1 of life with increment by 1 g/kg every day till a maximum of 4 g/kg/d, until babies tolerated 75% enteral feeds. Average postnatal weight gain (in g/kg/d)) by 28 days of life. Both groups had similar baseline characteristics. The gain in weight, length and head circumference at 28 days were significantly lower in the High AA group. The average weight gain at 28 days was 8.67g/kg/d in the High AA group and 13.15g/kg/d in the Low AA group (mean difference 123.12, 95% CI 46.67 to 199.37, P < 0.001). The incidences of neonatal morbidities associated with prematurity were similar in both groups. Higher initial parenteral aminoacid supplementation, in settings where partial parenteral nutrition is administered, results in poor growth in VLBW infants due to inadequate non-protein calorie intake.