High Early Amino Acid Intake in Preemies Might Have Positive Brain Effects

NEW YORK (Reuters Health) – For babies born before 30 weeks’ gestation, high early amino acid intake is safe and associated with improved cognitive development at 5 years of age, according to a large observational study from France.

Very preterm infants born at less than 32 weeks’ gestation are at high risk of developing cognitive difficulties, Dr. Jean-Christophe Roze of Nantes University Hospital and colleagues note in JAMA Network Open.

“Between 2000 and 2005, international expert committees recommended providing more than 3.50 g/kg/d of protein at the end of the first week after birth to match the net maternal-fetal amino acid transfer during the third trimester of gestation based on net leucine uptake, obligate protein loss, efficiency of protein retention, and required protein accretion,” they say.

But in 2018, a European expert committee revised these recommendations and suggested that amino acid intake above 3.50 g/kg/d be given only as part of clinical trials.

Dr. Roze and colleagues evaluated the association between early amino acid intake and cognitive outcomes at age 5 years using the national EPIPAGE-2 (Epidemiologic Study on Small-for-Gestational-Age Children – Follow-up at Five and a Half Years) cohort.

Among 1,789 infants born at less than 30 weeks’ gestation, 52% had amino acid intake greater than 3.50 g/kg/d (exposed group) and 48% did not (nonexposed group).

Based on a propensity-score-matched analysis of 717 infants from each group, early high amino acid exposure was “significantly and independently” associated with a higher likelihood of surviving with a full-scale IQ score greater than -1 SD at 5 years of age (61% vs. 54%, respectively; odds ratio, 1.33; 95% confidence interval, 1.00 to 1.17).

They also found a correlation between amino acid intake at seven days after birth as a continuous variable and full-scale IQ score.

In addition, among a subgroup of infants, they found a correlation between amino acid intake and white matter area or anisotropy of several white matter tracts identified by an MRI scan performed at term.

These findings, from “a national, prospective population-based cohort study (i.e., without selection bias) with wide practice variation, seem important to us,” Dr. Roze told Reuters Health by email.

While this remains an observational study, “waiting at least seven years for the results of a prospective randomized study with a five-year follow-up to recommend such an intake does not seem reasonable because it would be a loss of a chance for many premature infants under 30 weeks. Thus, high early amino acid intake must be recommended from my point of view,” Dr. Roze added.

SOURCE: https://bit.ly/3lmo94s JAMA Network Open, online November 30, 2021.

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