Amino acid requirements of total parenteral nutrition (TPN) fed neonates: a narrative review of current knowledge and the basis for a new amino acid solution in neonatal nutrition
Bibliographic record
Abstract
Background and Objective: Globally, an estimated 11% of births, approximately 15 million babies are born preterm per year. Preterm infants have unique nutritional needs. However, gastrointestinal immaturity and congenital anomalies often preclude enteral feeding, necessitating intravenously administered total parenteral nutrition (TPN). Metabolic immaturity affects amino acid metabolism and requirements, decreases tolerance to excess intakes and ability to synthesize dispensable amino acids. Parenterally fed neonates therefore are at risk of toxicity and deficiency of amino acids which negatively affect clinical outcomes. The objectives of this narrative review were to summarize current knowledge on amino acid requirements and describe the importance of appropriate composition of amino acids in parenteral nutrition formulas for neonates. Methods: Studies published on MEDLINE between 1950 and 2020 were included if they were conducted to determine amino acid requirements, evaluate parenteral amino acid solution, splanchnic amino acid metabolism in neonates or neonatal outcomes related to amino acid intake and protein quality. Key Content and Findings: The gut is an important site of amino acid metabolism and when it is bypassed, the requirements for many amino acids are lower for TPN than for enteral feeding. Yet, the amino acid profiles in current commercial TPN formulas are based on extrapolations from plasma amino acid concentrations, human cord blood or human breast milk composition. The requirement for four amino acids in the TPN fed human neonate have been estimated and are up to 90% lower or higher than what is present in current commercial solutions. These data provide confirmation that current amino acid solutions for the neonate are inappropriate. Conclusions: We conclude that Much work is left to be done to determine the requirements for the remaining indispensable and conditionally indispensable amino acids in the parenterally fed neonate. Only then, can an optimal pattern of amino acids be combined for formulating an appropriate parenteral amino acid solution for this vulnerable patient population.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".