Early Nutrition, Blood Amino Acids and Outcomes in Preterm Babies: Secondary Cohort Analysis of the ProVIDe RCT.

BACKGROUND

Providing optimal parenteral nutrition to extremely preterm babies in the first week after birth is challenging, and different strategies may be associated with both short- and long-term outcomes.

METHODS

In a secondary cohort analysis of the ProVIDe trial, a multicentre, randomised, controlled trial in extremely-low-birthweight babies of increased amino acid intake in the first five days after birth, we explored the associations between parenteral amino acid and lipid intakes and blood spot amino acid concentrations, clinical outcomes and neurodevelopment. The cohort comprised 382 babies born in six New Zealand hospitals of whom 342 survived to 28 days. Nutritional intake data in the first week and newborn metabolic screening data on days 1, 5, 14, and 28 were retrieved, and 294 children were assessed for neurodevelopmental outcome at 2 years' corrected age.

RESULTS

Blood spot amino acid concentrations were positively associated with amino acid intake (p < 0.005). Higher amino acid intakes were associated with increased odds (OR), 95% confidence intervals (CIs) of bronchopulmonary dysplasia (tyrosine: OR 2.2, CI 1.2-3.9; proline: OR 2.3, CI 1.3-4.0), patent ductus arteriosus and probable sepsis. No significant associations were found for necrotising enterocolitis. Higher lipid intakes were associated with lower odds of intraventricular haemorrhage (0.33 [0.16, 0.66]), bronchopulmonary dysplasia (0.31 [0.13, 0.73]) and retinopathy of prematurity (0.29 [0.12, 0.72]). Unlike short-term outcomes, neurodevelopment did not differ according to blood spot or intake quartile for any amino acid in week 1.

CONCLUSIONS

Parenteral nutritional intakes in the first week after birth are associated with short-term outcomes. Further research is needed to optimise the composition of amino acid solutions.

TRIAL REGISTRATION

ACTRN12612001084875, (accessed on 10 October 2012).