Other additives



Other additives

Heparin increases the clearance of lipid from the circulation; there is a belief, not backed up by any evidence, that addition of 1 IU/ml to parenteral nutrition solutions preserves i.v. line patency and promotes lipolysis. Preterm infants have low concentrations of carnitine, required for oxidation of long chain fatty acids; a Cochrane review evaluated the many studies of supplemental carnitine in parenterally fed newborns, and concluded that there was no evidence to support its use.
Other additives have been given to parenteral nutrition in the newborn to try to either improve clinical outcome or prevent adverse outcomes. Cysteine, cystine or N-acetyl cysteine supplementation has been parenterally fed to neonates. L-cysteine is a conditionally indispensable amino acid for neonates, and is a precursor of the antioxidant glutathione. A Cochrane review of six RCTs of mainly preterm infants, of which five were short term studies, concluded that the available evidence does not support the routine use of these substances. There has long been an interest in glutamine supplementation to prevent morbidity and mortality in preterm infants. In a Cochrane review of glutamine supplementation in preterm infants, six RCTs were identified, of which two (involving 1468 infants) were of parenteral glutamine administration. There was no evidence that the routine use of glutamine supplementation altered mortality or other important clinical outcomes for very low birth weight infants. Arginine can act as a substrate for the production of nitric oxide in the tissues and arginine supplementation may help in preventing NEC – decreased concentration of nitric oxide is proposed as one of the possible cellular mechanisms for NEC. A Cochrane review of arginine supplementation to parenteral nutrition to prevent NEC in preterm infants identified only one RCT, involving infants, and concluded that this was insufficient evidence and that a large multicenter RCT was required.

Source: Forfar and Arneil's Textbook of Pediatrics, 7E

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