Extra parenteral amino acids not beneficial for extremely preterm infants: NEJM

The study led to the following findings:

• In 47.8% of children in the intervention group, the researchers observed survival free from neurodisability and in the placebo group, 49.8% (adjusted relative risk, 0.95).
• Death before two years of age occurred in 18.0% of children in the intervention group and 19.4% in the placebo group; neurodisability occurred in 40.9% in the intervention group and 37.4% in the placebo group (adjusted relative risk, 1.16).
• Neurodisability was moderate to severe in 16.5% of children in the intervention group and 8.6% in the placebo group (adjusted relative risk, 1.95).
• More children in the intervention group had patent ductus arteriosus than in the placebo group (adjusted relative risk, 1.65).
• In a post hoc analysis, refeeding syndrome happened in 42 of 172 children in the intervention group and 26 of 166 in the placebo group (adjusted relative risk, 1.64).
• Eight serious adverse events occurred.

"In the placebo group, amino acid intake fell within the range of the most recent recommendation of 2.5 to 3.5 g per kg per day," the authors wrote. "Our results support these recommendations and suggest intake levels higher than this are not required to support growth and may have harmful effects on neurodevelopment."

Reference:

Bloomfield FH, Jiang Y, Harding JE, Crowther CA, Cormack BE; ProVIDe Trial Group. Early Amino Acids in Extremely Preterm Infants and Neurodisability at 2 Years. N Engl J Med. 2022 Nov 3;387(18):1661-1672. doi: 10.1056/NEJMoa2204886. PMID: 36322845.