Albumin synthesis in very low birth weight infants is enhanced by early parenteral lipid and high-dose amino acid administration

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• 作者：Hester Vlaardingerbroek^a ; ¹ ; Henk Schierbeek^a ; ^b ; Denise Rook^a ; Marijn J. Vermeulen^a ; Kristien Dorst^a ; Andras Vermes^c ; Johannes B. van Goudoever^a ; ^b ; ^d ; ^{h.vangoudoever@amc.uva.nl" class="auth_mail" title="E-mail the corresponding author} ; Chris H.P. van den Akker^a
• 关键词：Preterm infant ; Parenteral nutrition ; Anabolism ; Growth ; Stable isotopes ; Mass spectrometry
• 刊名：Clinical Nutrition
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：35
• 期：2
• 页码：344-350
• 全文大小：906 K

文摘

Albumin is one of the most important plasma proteins and plays a key role in many physiologic processes, such as preserving colloid osmotic pressure, scavenging radicals, and binding and transporting bilirubin, hormones, and drugs. However, albumin concentrations are often low in preterm infants during the first days of life.

We hypothesized that early parenteral lipid and high-dose amino acid (AA) administration to very low birth weight (VLBW) infants from birth onwards increases hepatic albumin synthesis rates.

Methods

Inborn VLBW infants were randomized to receive from birth onwards either 2.4 g amino acids/(kg^·d) (control group), 2.4 g amino acids/(kg^·d) plus 2 g lipids/(kg^·d) (AA + lipid group), or 3.6 g amino acids/(kg^·d) plus 2 g lipids/(kg^·d) (high AA + lipid group). On postnatal day 2, infants received a primed continuous infusion of [U-¹³C₆,¹⁵N]leucine. Mass spectrometry was used to determine the fractional and absolute albumin synthesis rates (FSR and ASR, respectively).

Results

In total, 28 infants (median gestational age 27 weeks (IQR 25–28), median birth weight 810 g (IQR 679–998) were studied. The median FSR was 6.5%/d in the control group, 10.6%/d in the AA group, and 12.3%/d in the high AA + lipid group, while the median was 84 mg/(kg^·d) in the control group, 138 mg/(kg^·d) in the AA group, and 160 mg/(kg^·d) in the high AA + lipid group.

Conclusion

A group of VLBW infants given parenteral nutrition containing lipids and high-dose amino acids showed a higher rate of albumin synthesis compared to infants receiving no lipids and standard amounts of amino acids during the first two days of life.