The influence of increased protein intake and L-carnitine supply on the outcomes of term newborns in intensive therapy

Authors

DOI:

https://doi.org/10.14739/2310-1237.2023.3.287511

Keywords:

children, nutrition assessment, intensive care, protein, newborn

Abstract

We studied the possibilities of increased protein and L-carnitine supplementation in full-term newborns with perinatal diseases to improve the results of intensive care.

Aim: to assess the impact of short-term increased protein consumption and L-carnitine supplementation by full-term newborns on the main indicators of treatment effectiveness in the intensive care unit.

Materials and methods. To check the impact of the proposed method of feeding newborns, the life indicators of 59 full-term children, who were randomly divided into two groups, were studied. The first group (n = 30) received standard nutrition with mother’s milk or formula, the second group (n = 29) received a food product fortified with a protein supplement and a subsidy of L-carnitine during hospital stay.

Results. Infants of both groups had statistically equivalent anthropometric characteristics at the beginning of the study. The proportions of infants of both sexes were within the 50 % percentile. Starting from the third week, caloric intake for the standard diet group (SG) and the enrichment group (FG), respectively, was 111.83 ± 7.19 kcal/kg/day, against 113.44 ± 5.61 kcal/kg/day, p = 0.0667. Per 1 g of protein, children in the FG group had amount of non-protein calories as 28.68 (27.50; 29.80) kcal/kg/day, compared to the indicator in the SG group of 42.37 (41.60; 38.00) kcal/kg/day, with U = 28.0000; p = 0.0001. Carnitine supplementation in the FG group led to an increase in the level of free carnitine in the last blood plasma samples, before the children were discharged home.

In general, the proposed nutrition strategy was accompanied by better indicators of the physical development of children, and a statistically probable faster recovery of body weight in the fortification group. Thus, the generalized indicator of body weight of children of the SG group was 3966.90 ± 439.08 g, compared to the FG group of 3554.62 ± 452.28 g, with p = 0.0033. In general, children who consumed more protein were transferred from the intensive care unit earlier – 12.00 (11.00; 16.00) days, against 10.00 (8.00; 12.00) days, with U = 235,00; p = 0.0024; previously discharged from the hospital – 26.50 (22.00; 31.00) days, against 21.00 (19.00; 27.00) days, with U = 267.00, p = 0.0109.

This strategy proved to be safe, as confirmed by normal levels of phenylalanine and urea at all stages of the examination of children.

Conclusions. Short-term increased protein consumption against the background of carnitine supplementation improves the results of physical development of newborns and indicators of hospitalization and intensive care unit stay. Larger studies and catamnestic observation of children are needed.

Author Biographies

I. O. Anikin, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, PhD, Associate Professor of the Department of Anesthesiology and Intensive Care

L. S. Stryzhak, Zaporizhzhia State Medical and Pharmaceutical University, Ukraine

MD, Assistant of the Department of Anesthesiology and Intensive Care

References

Mabhandi, T., Ramdin, T., Ballot, D. E. (2019). Growth of extremely low birth weight infants at a tertiary hospital in a middle-income country. BMC pediatrics, 19(1), 231. https://doi.org/10.1186/s12887-019-1568-6

Hee Chung, E., Chou, J., & Brown, K. A. (2020). Neurodevelopmental outcomes of preterm infants: a recent literature review. Translational pediatrics, 9(Suppl 1), S3-S8. https://doi.org/10.21037/tp.2019.09.10

Chen, Z., Xiong, C., Liu, H., Duan, J., Kang, C., Yao, C., Chen, K., Chen, Y., Liu, Y., Liu, M., & Zhou, A. (2022). Impact of early term and late preterm birth on infants' neurodevelopment: evidence from a cohort study in Wuhan, China. BMC pediatrics, 22(1), 251. https://doi.org/10.1186/s12887-022-03312-3

Koletzko, B., Godfrey, K. M., Poston, L., Szajewska, H., van Goudoever, J. B., de Waard, M., Brands, B., Grivell, R. M., Deussen, A. R., Dodd, J. M., Patro-Golab, B., Zalewski, B. M., & EarlyNutrition Project Systematic Review Group (2019). Nutrition During Pregnancy, Lactation and Early Childhood and its Implications for Maternal and Long-Term Child Health: The Early Nutrition Project Recommendations. Annals of nutrition & metabolism, 74(2), 93-106. https://doi.org/10.1159/000496471

Watchmaker, B., Boyd, B., & Dugas, L. R. (2020). Newborn feeding recommendations and practices increase the risk of development of overweight and obesity. BMC pediatrics, 20(1), 104. https://doi.org/10.1186/s12887-020-1982-9

Mısırlıoğlu, M., Yıldızdaş, D., Ekinci, F., Horoz, Ö. Ö., Özkale, Y., Özkale, M., Yöntem, A., Arslan, İ., & Tümgör, G. (2023). The Effects of Protein Intake on Clinical Outcome in Pediatric Intensive Care Units. Turkish archives of pediatrics, 58(1), 68-74. https://doi.org/10.5152/TurkArchPediatr.2022.22108

Moltu, S. J., Bronsky, J., Embleton, N., Gerasimidis, K., Indrio, F., Köglmeier, J., de Koning, B., Lapillonne, A., Norsa, L., Verduci, E., Domellöf, M., & ESPGHAN Committee on Nutrition (2021). Nutritional Management of the Critically Ill Neonate: A Position Paper of the ESPGHAN Committee on Nutrition. Journal of pediatric gastroenterology and nutrition, 73(2), 274-289. https://doi.org/10.1097/MPG.0000000000003076

Fu, M., Song, W., Yu, G., Yu, Y., & Yang, Q. (2023). Risk factors for length of NICU stay of newborns: A systematic review. Frontiers in pediatrics, 11, 1121406. https://doi.org/10.3389/fped.2023.1121406

Fenton, T. R., Al-Wassia, H., Premji, S. S., & Sauve, R. S. (2020). Higher versus lower protein intake in formula-fed low birth weight infants. The Cochrane database of systematic reviews, 6(6), CD003959. https://doi.org/10.1002/14651858.CD003959.pub4

Koletzko, B., Demmelmair, H., Grote, V., & Totzauer, M. (2019). Optimized protein intakes in term infants support physiological growth and promote long-term health. Seminars in perinatology, 43(7), 151153. https://doi.org/10.1053/j.semperi.2019.06.001

Richter, M., Baerlocher, K., Bauer, J. M., Elmadfa, I., Heseker, H., Leschik-Bonnet, E., Stangl, G., Volkert, D., Stehle, P., & on behalf of the German Nutrition Society (DGE) (2019). Revised Reference Values for the Intake of Protein. Annals of nutrition & metabolism, 74(3), 242-250. https://doi.org/10.1159/000499374

Yalçın, N., Kaşıkcı, M., Çelik, H. T., Demirkan, K., Yiğit, Ş., & Yurdakök, M. (2023). Development and validation of machine learning-based clinical decision support tool for identifying malnutrition in NICU patients. Scientific reports, 13(1), 5227. https://doi.org/10.1038/s41598-023-32570-z

Manninen, S., Silvennoinen, S., Bendel, P., Lankinen, M., Schwab, U. S., & Sankilampi, U. (2022). Carnitine Intake and Serum Levels Associate Positively with Postnatal Growth and Brain Size at Term in Very Preterm Infants. Nutrients, 14(22), 4725. https://doi.org/10.3390/nu14224725

Crefcoeur, L. L., de Sain-van der Velden, M. G. M., Ferdinandusse, S., Langeveld, M., Maase, R., Vaz, F. M., Visser, G., Wanders, R. J. A., Wijburg, F. A., Verschoof-Puite, R. K., & Schielen, P. C. J. I. (2020). Neonatal carnitine concentrations in relation to gestational age and weight. JIMD reports, 56(1), 95-104. https://doi.org/10.1002/jmd2.12162

Tuzun, F., Yucesoy, E., Baysal, B., Kumral, A., Duman, N., & Ozkan, H. (2018). Comparison of INTERGROWTH-21 and Fenton growth standards to assess size at birth and extrauterine growth in very preterm infants. The journal of maternal-fetal & neonatal medicine, 31(17), 2252-2257. https://doi.org/10.1080/14767058.2017.1339270

Published

2023-12-22

How to Cite

1.
Anikin IO, Stryzhak LS. The influence of increased protein intake and L-carnitine supply on the outcomes of term newborns in intensive therapy. Pathologia [Internet]. 2023Dec.22 [cited 2024Mar.2];20(3):271-80. Available from: http://pat.zsmu.edu.ua/article/view/287511

Issue

Section

Original research