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Carnitine supplementation of parenterally fed neonatesCairns PA, Stalker DJ
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SummaryCarnitine supplementation of parenterally fed neonatesNot enough evidence that carnitine supplements improve weight gain in parenterally fed newborns. Preterm newborns (born before 37 weeks) frequently need extra nutritional supplements parenterally (given other ways than by the mouth). Carnitine is an amino acid found in both breast milk and infant formulas but is not routinely given parenterally. It helps fatty acids to convert into energy and helps in growth. The review of trials found not enough evidence to show any benefit of parenteral carnitine supplements on weight gain or lipid tolerance in preterm newborns. More research is needed.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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October 23. 2000 AbstractBackgroundCarnitine, a quaternary amino acid, plays an important role in the oxidation of long chain fatty acids. Both breast milk and infant formulas contain carnitine. However, it is not routinely provided in parenteral nutrition solutions. Non supplemented parenterally fed infants have very low tissue carnitine levels. The clinical significance of this is uncertain. Carnitine deficiency may be an etiological factor in the limited ability of premature babies to utilize parenteral lipid. In vitro studies have suggested that fatty acid oxidation is impaired when the tissue carnitine levels fall below 10% of normal. Therefore relative carnitine deficiency may impair fatty acid oxidation, thus reducing the available energy and impairing growth. ObjectivesThe primary aim of this review is to determine whether carnitine supplementation of parenterally fed neonates will improve weight gain. Search strategyComputerised searches were carried out by both reviewers. Searches were made of Medline, Embase, The National Research Register (UK), the Cochrane Controlled Trials Register and expert informants. The MeSH headings used were carnitine and parenteral nutrition. Selection criteriaOnly randomised trials were considered. Trials were included if they involved carnitine supplementation alone, parenterally fed newborn infants, and measured at least one outcome of interest (weight gain, plasma fatty acids, plasma triglycerides, quantity of lipid tolerated, respiratory quotient or beta hydroxybutyrate levels). Data collection and analysisThe two reviewers searched the literature separately and reached a consensus for inclusion of trials. Data were extracted and evaluated by the two reviewers independently of each other. Authors were contacted if possible to clarify or provide missing data. Main resultsFourteen studies were identified, six met the selection criteria. The results of the review are limited by the fact that the studies were generally short term and studied different outcomes. One study examined short term and long term weight gain, three reported only short term weight gain, three reported biochemical results in response to a short lipid challenge, and two reported results obtained during normal parenteral nutrition. Among infants supplemented with carnitine, there was no evidence of effect on weight gain, lipid utilization or ketogenesis. Authors' conclusionsWe found no evidence to support the routine supplementation of parenterally fed neonates with carnitine. |