Branched-chain amino acid supplementation for improving nutrition in term and preterm neonates

Review question

Does supplementation of branched-chain amino acids (BCAAs) improve physical and neurological development and other health outcomes in term and preterm neonates?

Background

Although leucine, isoleucine and valine—a group of essential amino acids—play an important role in neonatal nutrition, the optimal dosages are still unknown. Neonates usually consume BCAAs from breast milk and artificial formula, and those treated in hospitals due to various problems, including premature birth, asphyxia (lack of oxygen) and infections, may take them in from infusion solutions. Suboptimal intake of BCAAs can be caused by poor sucking and by inappropriate infusion therapy as well, which might lead to poor growth and neurological impairment. Thus, we attempted to reveal whether BCAA supplementation can improve health outcomes in term and preterm neonates.

Study characteristics

We did not find any eligible randomised controlled trials that assessed the effect of BCAA supplementation for term and preterm neonates. The evidence is up to date as of August 2019.

Key results and conclusions

This review is unable to suggest the effect of BCAA supplementation on physical growth and neurological development in term and preterm neonates. Future studies are required as this assessment is very important in the neonatal field.

Authors' conclusions: 

We found no trial data to support or refute the idea that BCAA supplementation affects physical and neurological development and other outcomes in term and preterm neonates.

Read the full abstract...
Background: 

Branched-chain amino acids (BCAAs) play a vital role in neonatal nutrition. Optimal BCAA supplementation might improve neonatal nutrient storage, leading to better physical and neurological development and other outcomes.

Objectives: 

To determine the effect of BCAA supplementation on physical growth and neurological development in term and preterm neonates. We planned to make the following comparisons: parenteral nutrition with and without BCAA supplementation; enteral BCAA supplementation versus no supplementation; and any type of supplementation including enteral, parenteral and both ways versus no supplementation.

To investigate the supplementation effectiveness for different dosages assessed in the eligible trials.

Search strategy: 

We conducted comprehensive searches using Cochrane Neonatal's standard search strategies: Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 6), MEDLINE, Embase and CINAHL (up to July 2016). We updated the search with CENTRAL (2019, Issue 8), MEDLINE, Embase and CINAHL (up to August 2019). We also searched clinical trials registries and reference lists of retrieved articles.

Selection criteria: 

We planned to include individual and cluster-randomised and quasi-randomised controlled trials comparing BCAA supplementation versus placebo or no supplementation in term and preterm neonates. We excluded trials presented only as abstracts and cross-over trials.

Data collection and analysis: 

Two review authors independently assessed the eligibility of all potential studies identified from the search strategy. We planned to extract data using a pilot-tested standard data extraction form and assess risk of bias of the included studies following the methods described in the Cochrane Handbook for Systematic Reviews of Interventions. We planned to analyse treatment effects and report their effect estimates as per dichotomous or continuous data with 95% confidence intervals. We planned to conduct subgroup analysis to investigate heterogeneity, and perform sensitivity analysis where possible. We planned to use fixed-effect meta-analysis to combine data wherever appropriate. We planned to assess evidence quality using the GRADE approach.

Main results: 

We did not identify any potentially eligible studies that met the inclusion criteria in this review.

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