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Two parenteral amino acid solutions and plasma levels of amino acids in the neonate: A randomized trial

Anaya-Flórez, María Salomé, Barbosa-Cortés, Lourdes, Villasis-Keever, Miguel Angel, Aguilar-Monroy, Silvia, Montalvo-Velarde, Irene, López-Alarcón, Mardia, Lledias-Corona, Martha, Huerta-Tecanhuey, Andrea, Maldonado-Hernández, Jorge, Madrigal-Muñiz, Olivia, González-Cabello, Héctor
Nutrition 2018
amino acid composition, birth weight, blood sampling, breast milk, cholestasis, cysteine, gestational age, intravenous injection, liquid chromatography, methionine, neonates, risk factors, t-test, taurine, total parenteral nutrition, umbilical cord
In neonates on total parenteral nutrition (TPN), amino acids may be a risk factor for developing total parenteral nutrition–associated cholestasis (TPNAC). We aimed, first, to compare methionine, cysteine, and taurine plasma levels between neonates on TPN who were receiving an intravenous amino acid solution based on a breast milk aminogram and those on an intravenous solution of pediatric amino acids based on an umbilical cord aminogram, and second, to determine the frequency of TPNAC.A double-blind randomized controlled trial was conducted. Ninety-four neonates with a birthweight of 1000g or more and a gestational age of 30 wk or older were admitted and enrolled. Blood samples were obtained at 0, 7, and 14 d of TPN, and plasma amino acid concentrations were determined by ultra-high-resolution liquid chromatography. Continuous variables were compared using the Wilcoxon rank-sum test or Student's t test; categorical variables were compared using the Fisher exact test.Thirty-five neonates completed the study (Primene, n = 14; TrophAmine, n = 21). On day 14, methionine plasma concentrations were significantly lower in the Primene group than in the TrophAmine group (27 µmol/L versus 32.9 µmol/L, P = 0.044); the taurine concentration was significantly higher in the same group (72.4 µmol/L versus 45.3 µmol/L, P < 0.0001). There were no differences in TPNAC incidence.Administering an intravenous solution of pediatric amino acids based on the umbilical cord aminogram yielded a higher taurine and lower methionine plasma concentration than did administering a similar solution based on the breast milk aminogram.