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Effects of Early High-dose Amino Acid Supplementation on the Nutritional Status of Preterm Infants
J. Kor. Soc. Health-syst. Pharm. 2021;38:52-64
Published online February 28, 2021;
© 2021 Korean Society of Health-System Pharmacists

Hye Lim Ahn, Mi Jin Kim, Eyn Young Kwon

Department of Pharmacy, Seoul St. Mary’s Hospital, The Catholic University of Korea 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
Correspondence to: †교신저자 안혜림 Tel:02-2258-2522
Received September 22, 2020; Revised November 20, 2020; Accepted December 16, 2020.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background : A previous study reported that supplying an initial high-dose amino acid supplement to premature infants was effective in improving the growth rate. However, other studies reported the occurrence of adverse effects associated with parenteral nutrients, raising concerns about aggressive nutritional support. We aimed to evaluate the effects of an initial high-dose amino acid supply on nutritional improvement and safety in premature infants in clinical practice.
Methods : This study was designed for premature infants who were administered parenteral nutrition (PN) for at least two weeks in neonatal intensive care units (NICUs) from January 2016 through December 2018. The biochemical and nutritional data were compared between premature infants who received low-dose (LD, 1 to <2 g/kg/day), medium-dose (MD, 2 to <3 g/kg/day), and high-dose amino acids (HD, ≥3 g/kg/day) within 48 hours after birth.
Results : The changes in weight, total protein levels, and albumin levels were not significantly different between the three groups. Also, the duration of the NICU stay, duration of PN, maximal weight loss rate, and recovery time to birth weight showed no significant differences. There were no significant differences in blood urea nitrogen (BUN), serum creatinine (Scr), capillary pH, capillary pCO2, blood glucose, aspartate transaminase (AST), alanine transaminase (ALT), direct bilirubin (DB), serum calcium, or serum phosphorus. However, the median BUN tended to increase in the high-dose group at both weeks 1 and 2 comparted to the LD and MD groups (week 1: LD 28.4 mg/dL, MD 29.2 mg/dL, HD 37.7 mg/dL, p = 0.455; week 2: LD 14.2 mg/dL, MD 17.7 mg/dL, HD 19.4 mg/dL, p = 0.139).
Conclusion : There was no difference in improvements in nutritional status or adverse effects in premature infants given more than 3 g/kg/day or 2 to <3 g/kg/day of amino acids compared to 1 to <2 g/kg/day. Monitoring renal function is required when administering high-dose amino acids, considering the tendency of the BUN to rise.
Keywords : Parenteral nutrition, High-dose amino acid, Preterm infants, Nutritional support

February 2021, 38 (1)