Safety and efficacy of early and high-dose parenteral amino acid administration to preterm infants

With birth, an infant's continuous nutrient supply through the umbilical cord abruptly ends while the nutritional requirements remain high. Preterm infants do not tolerate full enteral feeding immediately after birth because of immature bowel functioning. Therefore, parenteral nutrition should be initiated as soon as possible, as a means to restrict the wasting of endogenous substrates and to maintain normal metabolism and growth. Nevertheless, many preterm infants fail to grow well, which may be related to inadequate administration of proteins, the driving force for tissue growth. Research has shown that relatively high doses of parenterally administered amino acids from birth onwards are safe for preterm infants and enhance protein accretion and thus growth. Future studies should also reveal the long-term effects of high-dose amino acid administration from birth onwards on neurodevelopment. In addition, effects of higher amounts of amino acids as well as those of early lipid infusion need to be defined.