Eric J Sulkers, Ewald Schlotzer,

Harry and

N Laftber, Herman Pieter JJ Sauer

J Degenhart,

Hildegard

ABSTRACT Parenterally fed preterm neonates are known to be at risk for carnitine deficiency. We studied substrate utilization

in low-birth-weight

trition

(TPN)

with

mg carnitine

vs 13 18

248

±

respectively). ‘ .d

‘

trations

at day

zmol/L

and

consisted protein

total

parenteral

nu-

(B) supplementation

7 were

of 1 1 g glucose and fat. Plasma

for free

for acyl carnitine

L, respectively.

receiving

without

of 48

. kg ‘ . d ‘ on days 4-7 (birth weights 1 334 ± 282 g, gestational age 32 ± 2 vs 32 ± 2 wk, A vs B,

TPN of both

g . kg

infants

(A) and

Indirect

carnitine

. kg ‘ . d carnitine

at day

birth

weight

was

also

higher

in group

suggested

that

carnitine

uptake

a relatively

± 56

7 showed

B (7, 5.5-9

vs 9,

=

might and

reflect

storage

concentrations at birth infants (7), and it was

immaturity in the

dosage

ofmechanisms

tissues

(7).

For

for

this

reason

was chosen.

and methods

Subjects received carnitine

infants,

infants

entered

carnitine-free supplementation.

TPN

priate-for-gestational-age age (SGA) of the

mean

the and Each

(AGA)

infants.

AGA

study

and

12 infants TPN with six appro-

six small-for-gestational-

was defined

for gestation,

protocol;

12 infants received group comprised as a birth

according

to the

2 SDs

weight growth

curves

of

Usher and McLean (8). SGA was defined as a birth weight > 2 SDs below the mean. For each patient, an individual SDS (SD score) was determined, defined as the actual birth weight of the infant minus the mean birth weight for gestational age, and divided

by

growth

the

curves

termined

Carnitine, low-birth-weight indirect calorimetry

this

Twenty-four

a higher

7-14 d, P < 0.05). Carnitine supplementation and calorie intake were the best explanatory variables for metabolic rate (R2 0.45, P < 0.002). We conclude that carnitine supplementation ofTPN in this dosage does not seem advisable. Am J C/in Nutr 1990;52:889-94.

KEY WORDS parenteral nutrition,

their plasma carnitine those in more mature

high carnitine

Subjects

± 1 5.4 tmol/

fat oxidation (0.21, -0.31 to +0.60 vs 1.18, 0.70 to 1.95 g. kg .d, respectively, P < 0.02, median and interquartile range) in group B and a higher protein oxidation (0.37, 0.300.43 vs 0.63, 0.53-0.88 g.kg1 .d’, P < 0.001). The time to regain

(6) even though are higher than

concen-

1 1 .8 ± 5.0 vs 164

3.8 ± 2.0 vs 33.9

calorimetry

and 2.4

Przyrembel,

SD

for

of Usher

by medical

that

gestational

and

McLean.

history

and

age

according

Gestational

score

to

the

age was de-

according

to Ballard

et

al(9).

total

All infants

Introduction Carnitine, /3-OH-r-trimethyl amino-butyric acid, is an essential cofactor in the transport of long-chain fatty acids across the mitochondrial membrane. Plasma carnitine deficiency was documented in newborn infants receiving carnitine-free total parenteral nutrition (TPN) (1 2). Carnitine deficiency may

were

Care

Unit

phia

Children’s

were

clinically

receiving

except dosage and

initially

(NICU)

admitted

to the

of the Academic Hospital.

stable

phototherapy,

and

Infants

could

breathing antibiotics,

Neonatal

Hospital enter

room

Intensive

Rotterdam/Sothe

study

if they

air at day 7 and

or any

other

for caffeine, which was administered to all infants adapted to keep plasma concentrations between

200

Infants

not

medication

in a 100

g/L.

were

only

included

after

Department

of

Pediatrics,

informed

consent

was ob-

,

have a negative mogenesis.

Studies neonates fatty acids, 5). However,

effect

on

fat clearance,

ketogenesis,

and

therFrom

on the effects of carnitine were based on concentrations and ketone clearance

on use of fatty acids in of triglycerides, free

bodies as indices of fat oxidation (1, 3rates offat emulsions are not equivalent

to oxidation rates. The aim of the study was to assess the effects of carnitine supplementation on fat oxidation, other substrate oxidation rates, and growth. Carnitine tissue stores are lowest in small premature infants AmJClin

Nuir

1990:52:889-94.

Printed

in USA.

© 1990 American

Society

the

Division

of

Neonatology,

Erasmus University Rotterdam, University Hospital/Sophia Children’s Hospital, Rotterdam, The Netherlands, and the Scientific Department, Fresenius AG, Oberursel, FRG. 2 Supported by NWO grant 900-528-057, the Sophia Foundation for Medical Research, and Fresenius AG, Bad Homburg, FRG. 3 Address reprint requests to Pu Sauer, Department of Pediatrics, Division of Neonatology, Erasmus University/Sophia Children’s Hospital, 160 Gordelweg, 3038 GE Rotterdam, The Netherlands. Received November9, 1989. Accepted for publication February 8, 1990. forClinical

Nutrition

889

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Effects of high carnitine supplementation on substrate utilization in low-birth-weight infants receiving total parenteral nutrition13

890

SULKERS

tamed

from

approved

at least by the

one

ofthe

medical

parents.

ethics

The

study

committee

protocol

ofthe

ET

AL

man)

was

hospital.

in the system

for changes

Studj’

groups

During

the study

form

a randomized

fore,

five children

in which tine.

the

period

it was

trial

of carnitine

were

routine

Thereafter

not

during

parenteral

possible

feeding

did

not

supplementation

tients admitted to the NICU until measurements formed on six AGA and six SGA very-low-birth-weight who

were

studied

stable

on

during

or without with a birth

day

7. After

carnitine-free carnitine weight

study

criteria

on

mean

birth

weight,

this,

TPN.

seven