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REVIEW ARTICLE
Korean J Pediatr 2015 March;58(3) :77-83.
Published online 2015 March 15.       
Nutritional strategy of early amino acid administration in very low birth weight infants
Byong Sop Lee
Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Corresponding Author: Byong Sop Lee ,Tel: +82-2-3010-3929, Fax: +82-2-3010-6978, Email: mdleebs@amc.seoul.kr
Copyright © 2015 by The Korean Pediatric Society
ABSTRACT
Relative to a fetus of the same gestational age, very low birth weight (VLBW) infants are more likely to be underfed and to undergo growth restriction during their early hospital stay. The current trend towards "early and aggressive" nutritional strategies in VLBW infants aims to overcome the early nutritional deficiency and thereby boost postnatal catch-up growth, simultaneously improving longterm neurodevelopmental outcomes. Although the minimum starting amino acid (AA) dose to prevent negative nitrogen balance is well established, the upper limit and the rate of increase of early AA doses are controversial. Most randomized controlled trials show that early and high-dose (target, 3.5 to 4.9 g/kg/day) AA regimens, with or without high nonprotein calories, do not improve long-term growth and neurodevelopment. High-dose AA supplementation may lead to early metabolic disturbances and excessive or disproportionate plasma AA levels, particularly in infants of very low gestational age. Further large studies are needed to clarify the optimal strategy for early administration of parenteral AA doses in VLBW infants.
Keywords: Infant | Premature | Amino acids | Parenteral nutrition | Growth and development
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