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Parenteral amino acid and metabolic acidosis in premature infants . BACKGROUND Aggressive parenteral nutrition ( PN ) including amino acids is recommended for low-birth-weight infants to prevent energy and protein deficit . Their impact on acid-base homeostasis has not been examined . METHODS We investigated the impact of dose and duration of parenteral amino acids , with cysteine , on acid-base parameters in 122 low-birth-weight infants . Premature infants < or=32 weeks , < or=1850 g , and receiving parenteral amino acids at 1.5 g/kg/d for an extended period ( > 24 hours ) , or 3 g/kg/d for a short ( 5 hour ) , extended ( 24 hour ) , or prolonged ( 3-5 days ) duration were included in the study . Data were obtained at age 0-3 days ( n = 43 ) or , when clinically stable , age 3-5 days ( n = 49 ) . Data from 30 infants , matched for birth weight and gestational age , receiving PN during the first 5 days after birth were also obtained . Acidosis was defined as pH < 7.25 . RESULTS Acidosis was evident in all infants between 2 and 5 days after birth . Infants with large patent ductus arteriosus ( PDA ) exhibited significantly ( p < .05 ) lower pH early , had higher blood urea nitrogen levels ( 26 +/- 9 vs 18 + 8 mg/dL ; p < .05 ) , and had greater weight loss ( approximately 17 % of birth weight ) when compared with infants without PDA . Gestational age , weight loss , and patent ductus arteriosus accounted for 65 % of variance in acidosis . CONCLUSIONS Low-birth-weight infants develop metabolic acidosis between 2 and 5 days after birth , irrespective of dose and duration of parenteral amino acid administration . Careful management of parenteral fluids and comorbidities may lower the incidence of acidosis and promote protein accretion .
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Intervention_Pharmacological
Parenteral amino acid
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Intervention_Pharmacological
Aggressive parenteral nutrition ( PN ) including amino acids
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Intervention_Pharmacological
parenteral amino acids
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Intervention_Pharmacological
cysteine
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Intervention_Pharmacological
parenteral amino acids
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Intervention_Pharmacological
PN
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Intervention_Pharmacological
parenteral amino acid administration
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Intervention_Pharmacological
parenteral fluids
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Outcome_Adverse-effects
Acidosis
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Outcome_Physical
lower pH
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Outcome_Physical
blood urea nitrogen levels
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Outcome_Physical
greater weight loss
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Outcome_Physical
Gestational age
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Outcome_Physical
weight loss
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Outcome_Physical
patent ductus arteriosus
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Participant_Condition
30 infants , matched for birth weight and gestational age , receiving PN during the first 5 days after birth