Amino acids in parenteral nutrition of preterm infants. Comparison of oral and parenteral supply

Parenteral feeding of preterm infants has been accepted as an alternative form of nutrition in those infants unable to accept oral feeding. The amount of amino acid nitrogen and the composition of the amino acid solution to be used, however, have not yet been defined. The amino acid intake and the plasma amino acid concentration of three groups of preterm infants were compared. Twenty-three infants were fed parenterally. Of these, 16 were studied during the first week of life (group I) and 7 during the second week (group II). A control group of 9 infants fed with oral formula was also studied in the second week (group III). In general, plasma amino acid concentrations in the parenterally fed groups were higher than in the orally fed group, in spite of a lower intake. Comparison of the amino acid intake of groups I and II relative to group III, with the plasma amino acid concentrations of groups I and II relative to group III, revealed a rather constant ratio with the exception of tyrosine and aspartic acid, where higher values were found. It is concluded that further increase in the amino acid nitrogen in parenteral feeding of preterm infants requires a more adapted preparation.     

AMINO ACIDS IN PARENTERAL NUTRITION OF PRETERM INFANTS

ABSTRACT. Parenteral feeding of preterm infants has been accepted as an alternative form of nutrition in those infants unable to accept oral feeding. The amount of amino acid nitrogen and the composition of the amino acid solution to be used, however, have not yet been defined. The amino acid intake and the plasma amino acid concentration of three groups of preterm infants were compared. Twenty-three infants were fed parenterally. Of these, 16 were studied during the first week of life (group I) and 7 during the second week (group II). A control group of 9 infants fed with oral formula was also studied in the second week (group III). In general, plasma amino acid concentrations in the parenterally fed groups were higher than in the orally fed group, in spite of a lower intake. Comparison of the amino acid intake of groups I and II relative to group III, with the plasma amino acid concentrations of groups I and II relative to group III, revealed a rather constant ratio with the exception of tyrosine and aspartic acid, where higher values were found. It is concluded that further increase in the amino acid nitrogen in parenteral feeding of preterm infants requires a more adapted preparation.     

Plasma amino acids in supplementary parenteral nutrition of preterm infants. Effect of different quantities of amino acid infusion and comparison with enteral feeding

The present investigation aims to determine quantity and quality of the amino acid (AA) solution to be used in supplementary parenteral nutrition (SPN). We established the plasma AA concentrations of preterm infants (birthweight 1160-1940 g, mean 1540; gestational age 29-30 weeks, mean 32) divided into three groups. Group I (n = 11) and group II (n = 12) were put on a standardised SPN regimen starting with an intravenous supply of 2.5 resp. 1.5 g AA/kg/day. Infants of group III were formula-fed, and served as controls. A total of 231 aminograms was obtained during the first two weeks of age. Comparison of groups I and II to group III revealed plasma accumulation of six AA in group I. Supplementation in group II resulted in a normal pattern, except alanine, proline, and methionine. However, only deviations of proline and methionine may be judged as imbalances, and lowering in composition may be considered. We conclude that the low intravenous AA intake employed in group II may be preferred in SPN of preterm infants.     

Decreased cholestasis with enteral instead of intravenous protein in the very low-birth-weight infant

Thirty to 50% of very low-birth-weight infants have parenteral nutrition-associated cholestasis. To test the hypothesis that the incidence of cholestasis would be decreased if parenteral amino acids were avoided and protein given enterally, infants with a gestational age of less than 30 weeks were randomized to two groups. One group received amino acid-free parenteral nutrition and whey protein enterally with added premature infant formula. The control group received standard parenteral nutrition with amino acids and enteral premature formula. At the end of 3 weeks of parenteral nutrition, infants who had a direct serum bilirubin level of greater than 3 mg/dl were considered to have significant cholestasis. Twenty-nine infants required parenteral nutrition for 3 weeks, 17 in the whey group and 12 in the control group. No instances of significant cholestasis were observed in the whey group (0/17), whereas seven of 12 infants (58%) in the amino acid control group had cholestasis (p less than 0.001).     

Plasma Amino Acids in Supplementary Parenteral Nutrition of Preterm Infants

ABSTRACT. The present investigation aims to determine quantity and quality of the amino acid (AA) solution to be used in supplementary parenteral nutrition (SPN). We established the plasma AA concentrations of preterm infants (birthweight 1160-1940 g, mean 1540; gestational age 29-30 weeks, mean 32) divided into three groups. Group I ( n =11) and group II ( n =12) were put on a standardised SPN regimen starting with an intravenous supply of 2.5 resp. 1.5 g A A/kg/day. Infants of group III were formula-fed, and served as controls. A total of 231 aminograms was obtained during the first two weeks of age. Comparison of groups I and II to group HI revealed plasma accumulation of six AA in group I. Supplementation in group II resulted in a normal pattern, except alanine, proline, and methionine. However, only deviations of proline and methionine may be judged as imbalances, and lowering in composition may be considered. We conclude that the low intravenous AA intake employed in group II may be preferred in SPN of preterm infants.     

Plasma amino acid concentrations in children receiving long-term parenteral nutrition

Plasma amino acid concentrations were measured in 15 children aged 4-65 months who received home parenteral nutrition (PN) and in 10 normal controls. In seven patients (Group I), PN was the only source of nutrition. Eight patients (Group II) ingested 30%-70% of their total energy requirements and received the remainder intravenously. Group I and Group II patients received PN for 25.6 +/- 14.4 (SD) and 25.7 +/- 19.1 months, respectively. In comparison to controls, Group I had significantly decreased plasma concentrations of total essential amino acids, the three branched chain amino acids, cystine, tyrosine, and the three major urea cycle amino acids. Group II children displayed decreased plasma concentrations of two branched chain amino acids, leucine and valine, as well as cystine and tyrosine. Taurine was decreased in both groups. The presence of liver disease did not have a major effect on amino acid levels. These data indicate that children receiving long-term parenteral nutrition will develop abnormalities in their plasma amino acid concentrations even though they appear to receive adequate amounts of amino acids in their intravenous solutions. Further studies will be necessary to assess whether modifying the intravenous intake of amino acids will normalize plasma amino acid concentrations in these children.     

积极肠外营养支持方案在胎龄<34周早产儿中的应用

目的 探讨积极肠外营养支持方案(高初始剂量氨基酸和脂肪乳)在胎龄<34周早产儿肠外营养中的近期疗效及耐受情况.方法 根据早期应用氨基酸和脂肪乳剂量不同,将2019年5月至2019年12月收治,生后24小时内入院、胎龄<34周138例早产儿随机分2组.积极肠外营养组69例,氨基酸自2.5 g/(kg·d)始,逐日增加1....     

The effect of three intravenous fat emulsions containing different concentrations of linoleic and alpha-linolenic acids on the plasma total fatty acid profile of neonates.

We determined the fatty acid profile of total plasma lipids in infants who received one of three intravenous fat emulsions that differed primarily in their linoleic and alpha-linolenic acid content: (I) a safflower oil emulsion, (II) a 50:50 mixture of safflower and soybean oils, or (III) a soybean oil emulsion. After 2 weeks of fat therapy, oleic acid, expressed as a percentage of total plasma lipid fatty acids, decreased in all groups, but less so in group III (p less than 0.01). The linoleic acid percentage increased in all groups, but group I had the greatest increase (p less than 0.05). Group II patients had higher percentages of the linoleic acid metabolites, dihomo-gamma-linolenic acid (II greater than I, p less than 0.05; II greater than III, p less than 0.01) and arachidonic acid (II greater than III, p less than 0.05). Group II patients also had higher levels of alpha-linolenic acid (II greater than I, p less than 0.05) and its metabolite, eicosapentaenoic acid (II greater than I, p less than 0.05). Another alpha-linolenic acid metabolite, docosahexaenoic acid, however, increased in group III, remained stable in group II, and decreased in group I (III and II greater than I, p less than 0.05). We conclude that the content of linoleic acid and alpha-linolenic acid in intravenous fat emulsions results in statistically significant changes in the fatty acid profile of total plasma lipids in infants receiving total parenteral nutrition.     

积极肠外营养支持方案在胎龄小于34周早产儿中的远期效果研究

目的 探讨应用积极肠外营养支持方案在胎龄小于34周早产儿肠外营养中的远期疗效。 方法 根据早期应用脂肪乳和氨基酸剂量的不同,将2019年5~12月收治的生后24 h内入院、胎龄小于34周的早产儿分为积极肠外营养组和常规肠外营养组,每组各50例,分别收集两组早产儿在随访6个月和13个月时的体格指标及Gesell发育量表测定值。 结果 6月龄时,积极肠外营养组早产儿（n=46）在大运动、精细运动、个人-社会性行为3个能区的发育商均显著高于常规肠外营养组（n=34）（P<0.05）;13月龄时,积极肠外营养组早产儿（n=25）在适应性行为、大运动、个人-社会性行为3个能区的发育商均显著高于常规肠外营养组（n=19）（P<0.05）。两组患儿在整个随访过程中的体重、身长、头围等体格发育指标差异均无统计学意义（P>0.05）。 结论 在生后24 h内给予胎龄小于34周早产儿含高剂量脂肪乳和氨基酸的积极肠外营养支持策略可显著改善其远期神经系统发育。     

The use of a crystalline amino acid mixture for parenteral nutrition in low-birth-weight infants.

Thirty-six preterm, sick, low-birth-weight neonates were given either total or partial parenteral nutrition. The patients were divided into three groups according to their birth weights: group A -less than 1,000 gm, 12 patients: group B--between 1,000 and 1,500 gm, 15 patients: group C--more than 1,500 gm, 9 patients. The solution for total parenteral nutrition contained 20% glucose and 2.6% crystalline amino acids plus appropriate amounts of vitamins and minerals. The volume of infusate given was usually 125 ml/kg/day, but varied depending on the clinical condition of the patient; occasionally it was as high as 150 to 175 ml/kg/day. Infusate of one-half strength was administered initially; its concentrations of glucose and amino acids were increased to three quarters and full strength gradually, if tolerated. The solution for total parenteral nutrition was infused into the superior vena cava via a central venous catheter; that for partial parenteral nutrition was given into a peripheral vein to supplement inadequate oral feedings. The period of parenteral nutrition lasted from 5 to 49 days, with an average of 13.2 days. The intake of 500 mg of nitrogen as crystalline amino acids and 100 kcal as glucose was capable of achieving body weight gain. Positive nitrogen balance of various degrees was also observed. Hyperglycemia of a slight to moderate degree was observed in nine patients; only three required insulin therapy. Two patients had thrombotic occlusion of the central venous catheter. The conclusion was reached that total parenteral nutrition or partial parenteral nutrition, when properly managed, is a safe procedure in small, premature infants. The amino acid solution given as a nitrogen source along with adequate calories was effective in promoting weight gain and nitrogen balance; it was apparently well tolerated by low-birth-weight neonates.     

Pediatric parenteral amino acid mixture in low birth weight infants

A mixture of amino acids designed to maintain normal plasma amino acid concentrations in infants and children requiring parenteral nutrition was evaluated in 28 low birth weight (LBW) infants (birth weight, 750 to 1750 g; postnatal age, 1 to 4 weeks) who required parenteral nutrients for optimal nutritional management. Sixteen babies received only parenteral nutrients for five to 21 days. Ten of these received a typical regimen by peripheral vein (1.91 +/- 0.16 g/kg/d of amino acids and 44.7 +/- 4.4 kcal/kg/d) and six received a typical regimen through a central vein (2.39 +/- 0.11 g/kg/d of amino acids and 95.9 +/- 14.5 kcal/kg/d). Mean weight gain of the peripheral vein subgroup was 10.3 +/- 10.6 g/kg/d; mean nitrogen balance was 230 +/- 66 mg/kg/d. Both the mean rate of weight gain (17.2 +/- 5.1 g/kg/d) and the mean rate of nitrogen retention (267 +/- 49 g/kg/d) of the central vein subgroup were similar to intrauterine rates. In these two subgroups as well as the total population, plasma concentrations of all amino acids except phenylalanine were within the 95% confidence limits of the plasma concentrations observed in LBW infants fed sufficient amounts of human milk to result in a rate of weight gain similar to the intrauterine rate. However, although plasma tyrosine and cyst(e)ine concentrations were within the 95% confidence limits of the plasma concentrations goals, the LBW infant's ability to use N-acetyl-L-tyrosine and cysteine HCl appears to be even less than that of the term infant and older child. In toto, these data support the efficacy of the amino acid mixture evaluated for LBW infants. Of equal importance, they suggest that the LBW infant's ability to use parenterally delivered amino acids is not as limited as commonly thought.     

早期输注大剂量氨基酸对改善早产儿氮平衡的有效性研究

目的评价早期输注大剂量氨基酸对改善早产儿氮平衡的有效性。方法将2010年1月—2010年12月间出生24 h内体质量1 000～2 000 g入住新生儿重症监护室(NICU)接受肠道外营养治疗的早产儿,随机分为两组。实验组于生后24 h内输注氨基酸2.0 g/(kg.d)起,每天增加0.85 g/kg,预期峰值3.7 g/(kg.d);对照组于出生24 h内输注氨基酸0.5 g/(kg.d)起,每天增加0.5 g/kg,预期峰值3.7 g/(kg.d)。结果实验组早产儿生后第1周均处于正氮平衡;对照组早产儿生后前3 d均处于负氮平衡;实验组早产儿第1周每天平均氮平衡值均大于对照组,差异有统计学意义(P均<0.01)。实验组早产儿体质量下降百分比少于对照组,差异有统计学意义(P<0.05);头围增长大于对照组,差异有统计学意义(P<0.05);达到肠内营养418.4 kJ/kg的天数、恢复出生体质量的天数和体质量达到2 000 g的天数均少于对照组,差异有统计学意义(P均<0.05)。结论早产儿生后24 h内即开始输注大剂量氨基酸(2.0 g/kg)能显著改善氮平衡,增加喂养耐受性和促进早产儿生长。     

Increased parenteral amino acid administration to extremely low-birth-weight infants during early postnatal life

BACKGROUND: Early administration of parenteral amino acids to infants with extremely low birth weight (birth weight < or = 1,000 g) has been encouraged to foster growth. However, excessive intravenous intake of amino acids may cause metabolic acidosis and uremia in extremely low birth weight infants. The hypothesis for this study was that extremely low birth weight infants would tolerate slightly increased early postnatal parenteral amino acid administration and benefit. METHODS: The peak daily parenteral amino acid dosage was increased from 3 g/kg (standard group) to 4 g/kg (modified group). The corrected parenteral amino acid dosage was computed to account for enteral protein intake and keep the combined daily intravenous amino acid and enteral protein intake at or below 3 g . kg -1 . d -1 in the standard group and 4 g . kg -1 . d -1 in the modified group. The primary outcome measure was plasma bicarbonate concentration as an indicator of acid-base status. Data were collected for patient demographics, nutritional intake, serum bicarbonate and serum urea nitrogen concentrations, and outcome. RESULTS: The corrected parenteral amino acid intake of the modified group was 16% greater at postnatal week 1 (3.30 +/- 0.83 g . kg -1 . d -1; mean, +/-1 SD) and 18% greater (3.86 +/- 0.94 g . kg -1 . d -1 ) at postnatal week 2 than the parenteral amino acid intake of the standard group. In the modified group, the mean serum bicarbonate concentration was 19.1 +/- 1.8 mEq/dL at week 1 and 23.9 +/- 2.9 mEq/dL at week 2, with no difference between the groups. At week 1, serum urea nitrogen concentrations were the same in both groups. The mean serum urea nitrogen concentration of the modified group at postnatal week 2 (18.2 +/- 8.8 mg/dL) was unchanged from postnatal week 1, but was greater than that of the standard group at postnatal week 2. Weight gain was the same in both groups. Corrected parenteral amino acid intake at postnatal week 1 correlated directly with weight gain from birth to postnatal week 2 ( P < 0.03) in both groups. CONCLUSIONS: Infants with extremely low birth weight tolerated parenteral amino acid intake of approximately 4 g . kg -1 . d -1. Mild increases of mean serum urea nitrogen concentration and mean weight gain were associated with increased parenteral amino acid administration without significant acidosis.     

早产儿早期静脉营养耐受性的探讨

目的 探讨早产儿生后1～2d对静脉营养的耐受性。方法 将不能完全耐受肠道营养的早产儿34例(胎龄29～36周，体重900～1800g)，随机分为两组，实验组于生后48h内添加氨基酸及脂肪乳；对照组采用传统的静脉营养方法，即生后第3天应用氨基酸，第5天应用脂肪乳，同时均根据病情尽早经口微量喂养。两组患儿均于生后第1天及第7天采血，监测血清游离脂肪酸、总胆红素、直接胆红素、白蛋白、甘油三脂、总胆固醇，每天监测体重、微量血糖及经皮胆红素值。比较两组患儿恢复出生体重的时间、血清游离脂肪酸、胆红素及血脂的变化。结果 1)实验组患儿恢复出生体重的时间较对照组短；2)两组患儿生后相同日龄测得血清游脂肪酸、总胆红素、直接胆红素、甘油三脂、总胆固醇及血清游离脂肪酸与白蛋白的摩尔比均无显著差异。结论 早产儿生后1～2d可耐受全或部分肠道外营养。     

谷氨酰胺在早产儿肠外营养中的应用研究

目的研究谷氨酰胺(Gln)对早产儿的生长发育、胃肠功能成熟及感染发生率的影响。方法将35例早产儿分为两组,Gln组给予经静脉添加Gln的肠外营养(PN),对照组常规 PN,PN时间均大于2周。监测两组生长发育、喂养耐受情况、胃肠功能及感染发生率。结果 Gln 组生后4周时尿素氮(BUN)水平较对照组高(P=0．044),但仍在正常范围内。平均PN及平均住院时间Gln组均明显短于对照组(P=0．031;P=0．020)。血清胃动素水平Gln组生后2周较生后 3天明显升高(P=0．037);Gln组生后2周较生后3 d胃电节律中节律过快的百分数明显增加 (P=0．017)。Gln组发生感染的次数较对照组明显减少(P=0．001)。结论初步观察提示Gln 有助于早产儿胃肠功能的成熟,减少院内感染的发生。     

静脉补充谷氨酰胺对外科手术新生儿喂养耐受的影响

目的 评价含丙氨酰谷氨酰胺(Ala-Gin)肠外营养(PN)对接受外科手术新生儿喂养耐受的影响.方法 对两家儿童医疗中心2006年1月至2007年1月收治的40例接受外科手术的新生儿进行研究,采用平行、随机、双盲、对照实验,随机分为常规PN组(对照组)和常规PN+Ala-Gln组(研究组),二组各20例,对照组氨基酸的剂量为2～3g·kg-1·d-1;研究组添加0.3g·kg-1·d-1 Ala-Gln双肽,其中Ala-Gln双肽取代了处方中相应氨基酸的量.首要终点指标为术后开始喂养时间,术后达到全肠内喂养天数(标准配方摄入量≥120 ml·kg-1·d-1)、完全脱离肠外营养时间和病死率.结果 研究组和对照组比较,患儿术后开始喂养时间[研究组(8±4)d,对照组(8±5)d]、术后达到全肠内喂养天数[研究组(14±8)次,对照组(15±7)次]以及完全脱离肠外营养时间[研究组(15±8)d,对照组(16±7)d]差异均无统计学意义.对照组有3例死亡,研究组患儿无死亡,病死率通过非意向性分析,二组比较差异有统计学意义,OR值为0.789,95%CI为0.626～0.996.但是通过意向性分析,OR值为0.706,95%CI为0.136～3.658,病死率比较差异没有统计学意义.结论 本研究显示,静脉补充谷氨酰胺未能使接受外科手术的新生儿减少术后开始喂养时间和术后达到全肠内喂养天数,缩短全肠外营养应用时间;但关于是否能够降低患儿病死率,通过意向性分析和非意向性分析的结果有差异,尚需进一步研究.     

Intravenous lipid emulsions in the treatment of essential fatty acid deficiency: studies in young pigs

Essential fatty acid deficiency (EFAD) occurs in infants fed fat-free mixtures of glucose and amino acids. Although infusion of lipid emulsion rapidly reverses clinical symptoms, little is known about effects on tissue fatty acids. To study this question, five groups (n = 4/group) of neonatal pigs were studied. Three groups (I, II, and V) were made EFAD by feeding diets without essential fatty acids (EFA) for days 5 to 33 of life. Groups III and IV were fed a control diet. By 33 days, animals fed the deficient diet showed clinical symptoms and biochemical signs of EFAD. On days 33 to 54 of life, group I animals were fed the EFA-deficient diet and infused with lipid emulsion, providing 3.6% of energy as linoleic acid; group II animals were fed the deficient diet and infused with linoleic acid at 7.2% of energy; group V animals were fed the deficient diet with no lipid emulsion; group III and IV animals were fed the EFA-deficient diet and provided EFA intravenously. Infusion of lipid emulsion rapidly reversed clinical symptoms of EFAD and returned plasma phospholipid omega 6 fatty acids levels to normal. However, erythrocyte and liver phospholipid omega 6 fatty acid content and adipose tissue reserves of omega 6 fatty acids normalized more slowly. Three weeks of infusion of linoleic acid at 3.6% of energy and 2 weeks of infusion at 7.2% of energy were required to return erythrocyte phospholipid fatty acids to normal. Liver phospholipid fatty acid composition still showed biochemical evidence of EFAD in animals treated with linoleic acid at 3.6% of energy for 3 wk.(ABSTRACT TRUNCATED AT 250 WORDS)     

A double blind comparison of a new paediatric amino acid solution in neonatal total parenteral nutrition

All infants requiring parenteral nutrition over a continuous 13-month period were allocated to receive either Vamin or a new paediatric amino acid solution, Paedmin, as their protein source in a double blind prospective study. Those of 32 weeks gestation and less gained weight more rapidly when fed Paedmin than Vamin (P less than 0.004), but there were significant changes in liver function after 14 days nutrition. Babies of 33 weeks gestation and greater gained weight more rapidly when fed Vamin than Paedmin (P less than 0.003) but without liver function changes. There were no differences in the rate of head growth. Amino acid analysis of serum and urine showed a greater urinary loss of amino acids for a given serum concentration in babies of 32 weeks and less for both nutrition groups. The apparent benefit of Paedmin in the immature group of infants must be further evaluated and weighed against changes in liver function.     

Amino acid mixture designed to maintain normal plasma amino acid patterns in infants and children requiring parenteral nutrition

A mixture of amino acids designed to maintain normal plasma amino acid concentrations of infants and children requiring parenteral nutrition was evaluated in 40 infants and children receiving only parenteral nutrients (2.39 +/- 0.26 g/kg/d of amino acids and 110.3 +/- 10.4 kcal/kg/d) for five to 21 days. The children ranged in weight from 2.0 to 12.6 kg (median weight, 3.83 kg; fifth to 95th percentile, 2.06 to 11.1 kg) and in age from 1 week to 43.6 months (median age, 2.7 months; fifth to 95th percentile, 0.2 to 25.3 months). Mean weight gain was 11.0 +/- 5.0 g/kg/d; mean nitrogen balance was 242 +/- 70 mg/kg/d. Plasma concentrations of all amino acids except tyrosine were within the normal range (ie, within the 95% confidence limits of the two-hour postprandial plasma concentrations observed in 30-day-old, healthy, normally growing, breast-fed, term infants) throughout the period of study. Mean prestudy and poststudy serum total protein, albumin, and transthyretin (prealbumin) concentrations were not significantly different. However, plasma transthyretin concentration increased in all children with low prestudy concentrations. Mean poststudy serum total bilirubin concentration of the total population was not different from the mean prestudy concentration. This was true also for the 31 children who received the parenteral amino acid mixture for more than ten days. In contrast to the expected 30% to 50% incidence of cholestasis, only one of these 31 experienced an unexplained increase in serum total bilirubin concentration during study, suggesting that normalizing plasma amino acid concentrations and/or providing taurine during parenteral nutrition may decrease the incidence of cholestasis associated with this therapy.     

Low birthweight infants and total parenteral nutrition immediately after birth. II. Randomised study of biochemical tolerance of intravenous glucose,amino acids,and lipid.

This randomised study aimed to compare the biochemical tolerance of three parenteral regimens administered during the first 48 hours of life. Twenty nine infants were randomised to either: (a) glucose 10%; (b) glucose 10%/amino acids; (c) glucose 10%/amino acids/lipid. Blood samples for plasma amino acid profiles, cholesterol, and triglyceride concentrations were taken on arrival in the neonatal unit and again between 36 and 48 hours of life. Arterial or capillary blood gas analysis and blood glucose estimates were performed routinely during the first 48 hours of life. There was a sharp decline in plasma amino acid concentrations in the group following (a) compared with the two groups following (b) and (c) regimens. In all groups plasma triglyceride and cholesterol were not significantly different before and after 48 hours of lipid infusion. Peak mean (SE) bilirubin concentrations (203 (12) v 181 (19) v 220 (20) mumol/l) and the need for phototherapy (nine v eight v five infants) were similar for each of the groups. Hypoglycaemia occurred most frequently during the (b) regimen and least commonly in the (c) group. There are potential health gains from giving parenteral nutrition to low birthweight infants immediately after birth, and this study indicates that restriction of nutritional intake immediately after birth in preterm infants may cause significant metabolic disturbance. This can be prevented by starting a regimen of intravenous amino acids and lipid immediately after birth.