Evaluation of carnitine nutritional status in full-term newborn infants (original) (raw)
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Relative Bioavailability of Carnitine Supplementation in Premature Neonates
Background: Carnitine is an important nutrient in the infant diet. We compared total plasma carnitine concentrations in premature neonates supplemented with carnitine via parenteral and enteral nutrition. Methods: This is a post hoc analysis of plasma total carnitine concentrations and carnitine intake in neonates randomized in a previous study to receive 20 mg/kg/d carnitine supplementation over 8 weeks. Neonates received L-carnitine initially via parenteral nutrition (PN). When neonates were fed enterally, oral supplementation of L-carnitine was given in divided doses with each feeding. Results: Sixteen neonates (27 Ϯ 2 weeks gestation; 2.9 Ϯ 1.0 days postnatal age at enrollment; 965.6 Ϯ 279.1 g birth weight) are included. Concentrations were below reference range (31.1-60.5 nmol/mL) at baseline and exceeded reference range from week 1 through the last study period. Concentrations were not different from week 1 (108 Ϯ 49) through weeks 4 (87 Ϯ 34) and 8 (83 Ϯ 31). Carnitine intakes and concentrations were compared in neonates receiving 100% parenteral carnitine at week 1 (n ϭ 6) and 100% enteral carnitine at week 8 (n ϭ 8). Concentrations at week 1 (100.1 Ϯ 27.9) were not different (p ϭ .19) from week 8 (78.6 Ϯ 29.3); an estimate of relative bioavailability was 78.6%. Bioavailability with paired analysis of neonates (n ϭ 5) receiving 100% parenteral carnitine at week 1 and 100% enteral carnitine at week 8 was 83.7% Ϯ 41.2% (30.1%-140.6%). Conclusions: Parenteral and enteral supplementation of 20 mg/kg/d carnitine results in plasma total carnitine concentrations that exceed the reference range. Concentrations are not different between parenteral to enteral supplementation, suggesting that enteral carnitine is well absorbed when given daily in divided doses with enteral feedings.
Clinical Nutrition, 2006
Carnitine may be considered conditionally essential in the neonatal population. The purpose of this study was to evaluate the effects of long-term carnitine supplementation on total carnitine status and morbidity in premature neonates.In this prospective, randomized, placebo-controlled, double-blinded study, premature neonates received carnitine supplementation (20 mg/kg/day) or placebo. Plasma (nmol/ml) and red blood cell (RBC) (nmol/mg hemoglobin) total carnitine concentrations, 24-h nitrogen excretion, intake and weight, and respiratory, gastroesophageal, and infectious morbidity were assessed.Twenty-nine neonates (13 placebo, 16 carnitine; 27±2 weeks gestation; 976±259 g birthweight) were studied for up to 8 weeks. Plasma total carnitine concentrations exceeded the reference range in the carnitine group (weeks 1–8); however, concentrations did not reach reference range until week 4 in the placebo group. RBC total carnitine concentrations increased, but remained below reference range in both the carnitine (weeks 1–6) and placebo (weeks 1–8) groups. Carnitine group neonates regained their birthweight more rapidly than placebo group neonates (day of life 11.8±6 vs. 16.9±6.3, P=0.034P=0.034). In addition, percent periodic breathing calculated from cardiopulmonary trend monitor data (weeks 1–8) was lower in the carnitine group (0.4±0.9 vs. 1.4±1.9, P=0.014P=0.014). There was no difference with respect to other markers of respiratory, gastroesophageal and infectious morbidity or nitrogen balance.Carnitine supplementation at 20 mg/kg/day results in increased plasma and RBC total carnitine concentrations, has a positive effect on catch-up growth, and may improve periodic breathing in premature neonates.
Journal of Pediatric Gastroenterology & Nutrition, 2013
Objective: The aim of the study was to compare plasma carnitine profiles in fortified human milk (HM)-fed preterm infants or formula-fed preterm infants. Methods: Plasma acylcarnitine concentrations were determined in 20 formula-fed and 18 HM-fed preterm infants (birth weights between 1000 and 2200 g) by isotope dilution ESI MS/MS technique on study days 0, 14, and 28. Results: Concentrations of free carnitine (FC) and different acylcarnitines did not change during the 4 weeks of the study in infants fed HM. In contrast, in infants fed formula FC increased markedly (day 0: 29.989 [16.646] mmol/L, median [interquartile range], day 14: 43.972 [8.455], P < 0.05) along with increases of short-chain esters (C2 day 0: 5.300 [3.272], day 14: 6.773 [2.127], P < 0.05; C3 day 0: 0.070 [0.059], day 14: 0.110 [0.069], P < 0.05). In contrast, some medium-chain (C8:1, C12) and long-chain esters (C14, C16) decreased significantly in infant formula by day 14, whereas FC and C2 and C3 esters increased further by day 28 (FC: 47.672 [14.753], C2: 7.430 [4.688], C3: 0.107 [0.047]). Conclusions: The altered carnitine ester profile likely reflects active involvement of the carnitine molecule in the buffering, metabolism, and elimination of nonphysiological acyl moieties.
International Journal of Neonatal Screening
Currently, there is no evidence in the literature to support the routine supplementation of all parenterally fed premature infants with l-carnitine. In our study, we found that about 8.56% of extremely preterm neonates are diagnosed with carnitine deficiency secondary to malnutrition, either due to reduced stores at birth or related to total parenteral nutrition (TPN). Our two step approach of performing newborn screening (NBS) again at 32 weeks gestational age (GA) equivalent helps to diagnose 81.4% more preterm babies with carnitine deficiency—who would otherwise be missed—and supplement them with l-carnitine for optimal growth. We performed a retrospective cohort study to diagnose carnitine deficiency related to malnutrition in two groups: those presenting at birth and those presenting later in life. We found that there was a statistically significant difference in the median GA and birth weight (BW) between the two groups, but there was no difference in the free carnitine levels.
Carnitine concentrations in term and preterm newborns at birth and during the first days of life
PubMed, 2005
Carnitine plays an important role in energetic metabolism. The aim of the study was to characterize the carnitine status in term and preterm newborns with respect to gestational age, birth weight, haematocrit and red blood cell count (RBC). The effect of nutrition on carnitine levels in the first week of life was also studied. Total blood pool of free carnitine (FC), acylcarnitines (AC) and total carnitine (TC) were analysed in whole cord blood and postnatally in capillary blood obtained at the day 4-6 in 33 term newborns and at the day 7-10 in 27 preterm newborns using tandem mass spectrometry. Plasma level of carnitine in the cord blood was measured using radioenzymatic method. Cord plasma levels of FC, AC and TC were higher in preterm newborns in comparison with term newborns (p < 0.01), but the total blood pool of FC and TC in whole cord blood was lower in preterm newborns than in term newborns (p < 0.01) and positive correlation was found between FC and gestational age or birth weight (p < 0.05). In addition, positive correlation was found between AC and red blood cell count or haematocrit (p < 0.05). During the first week of life, blood pool of FC and TC in term newborns and AC and TC in preterm newborns decreased regardless of the type of enteral or parenteral nutrition. Our results indicate that preterm newborns are born with limited carnitine store. Interpretation of carnitine analyses in whole blood relies in addition to gestational age and birth weight on the haematocrit, especially in newborns with anaemia or blood hyperviscosity.
Randomised controlled trial of L-carnitine as a nutritional supplement in preterm infants
Archives of Disease in Childhood - Fetal and Neonatal Edition, 1998
Aims-To evaluate the eVect of L-carnitine supplementation (25 mg/kg/d) on the growth and incidence of hypoglycaemia in preterm infants. Methods-A double blind, placebo controlled randomised trial, stratified for gestational age, was conducted of 86 preterm infants between 28 and 34 gestational weeks. The median gestational ages in the carnitine group and placebo groups were 30.7 weeks (range 28.0 to 33.6) and 31.4 weeks (range 28.0 to 33.9), respectively. The median birthweights were 1.557 kg (range 0.944 to 2.275) and 1.645 kg (range 0.885 to 2.545), respectively. Results-Mean plasma free carnitine concentrations were below values for normal term infants in both groups on day 1 (carnitine group 44.8 µmol/l, placebo group 25.5 µmol/l) in the placebo group on day 7 (50.7 µmol/l), but in neither group on days 14 and 28. Total, free, and acylcarnitine concentrations were significantly increased in both urine and blood in the L-carnitine group. There was no significant diVerence between the placebo and carnitine supplemented groups in growth rate, as assessed by weight, length, skinfold thickness and head circumference measurements, or in the incidence of episodes of hypoglycaemia. Conclusion-The addition of carnitine as a nutritional supplement at a dose of 25mg/kg/day did not improve growth in our group of preterm infants nor protect them from episodes of hypoglycaemia.
Neonatal Blood Carnitine Concentrations: Normative Data by Electrospray Tandem Mass Spectometry
Pediatric Research, 2003
Despite a number of published reports, there is limited information about carnitine metabolism in the newborn. To establish normative data, we analyzed whole-blood carnitine concentrations in 24,644 newborns at age 1.85 Ϯ 0.95 d and umbilical cord whole blood and plasma carnitine concentrations in 50 full-term newborns. Total carnitine (TC), free carnitine (FC), and acylcarnitine (AC) were measured by electrospray tandem mass spectrometry. AC/FC ratios were derived from these measurements. The entire cohort was stratified according to TC values into a middle TC group representing 90% of the population and lower and upper TC groups representing 5% of the population, respectively. Normative data were derived from the middle TC group of full-term infants (N ϭ 19,595). TC was 72.42 Ϯ 20.75 M, FC was 44.94 Ϯ 14.99 M, AC was 27.48 Ϯ 8.05 M, and AC/FC ratio was 0.64 Ϯ 0.19 (ϮSD). These values differed significantly from umbilical cord whole blood TC values of 31.27 Ϯ 10.54 M determined in 50 samples. No meaningful correlation was found between TC and gestational age or birth weight in any group. In controlled analyses, prematurity was not associated with TC levels, whereas low birth weight (Ͻ2500 g) and male sex were significantly associated with higher TC levels. The association of low birth weight with higher TC values may be related to decreased tissue carnitine uptake. The sex effect may be related to hormonal influences on carnitine metabolism. Our study provides normative data of carnitine values measured by the highly precise method of electrospray tandem mass spectrometry in a large cohort of newborns and provides the basis for future studies of carnitine metabolism in health and disease states during the neonatal period. 829, 2003) Abbreviations MS-MS, electrospray tandem mass spectrometry TC, total carnitine FC, free carnitine AC, acylcarnitine RBC, red blood cells OR, Odds ratio CI, 95% confidence interval RE, radioenzyme ABSTRACT 823 RE: 29.39 Ϯ 14.99 MS: 29.80 Ϯ 7.63 RE: 13.99 Ϯ 11.16 MS: 9.98 Ϯ 6.54 Intermediate values set (N ϭ 19) FC Ն 46.0, FC Յ 75.9 RE: 49.67 Ϯ 17.81 MS: 71.02 Ϯ 16.54
The American journal of clinical nutrition, 1990
Parenterally fed preterm neonates are known to be at risk for carnitine deficiency. We studied substrate utilization in low-birth-weight infants receiving total parenteral nutrition (TPN) with (A) and without (B) supplementation of 48 mg carnitine.kg-1.d-1 on days 4-7 (birth weights 1334 +/- 282 vs 1318 +/- 248 g, gestational age 32 +/- 2 vs 32 +/- 2 wk, A vs B, respectively). TPN consisted of 11 g glucose.kg-1.d-1 and 2.4 g.kg-1.d-1 of both protein and fat. Plasma carnitine concentrations at day 7 were for free carnitine 11.8 +/- 5.0 vs 164 +/- 56 mumol/L and for acyl carnitine 3.8 +/- 2.0 vs 33.9 +/- 15.4 mumol/L, respectively. Indirect calorimetry at day 7 showed a higher fat oxidation (0.21, -0.31 to +0.60 vs 1.18, 0.70 to 1.95 g. kg-1.d-1, respectively, P less than 0.02, median and interquartile range) in group B and a higher protein oxidation (0.37, 0.30-0.43 vs 0.63, 0.53-0.88 g.kg-1.d-1, P less than 0.001). The time to regain birth weight was also higher in group B (7, 5.5-9...
P.73 Carnitine esters: markers of ‘carnitine insufficiency’in preterm and term neonates
Clinical Nutrition, 1996
Recovery of samples spiked with 1 #g/I vitamin K 1 was 97% for normolipidaemic samples and 95% for hyperlipidaemic samples. Plasma vitamin K1 samples from fasting healthy volunteers with normal plasma cholesterol (<5.2~m01/I) and triglyceride (<2.3mmol/I) were compared with those with elevated plasma lipids. Results: (median, range in brackets) Cholesterol Triglyceride Vitamin K 1 (mmol/I) (mmol/I) (~Lg/I) Norrnolipidaemic (n = 17) 4.70 (2.70-5.20) 1.00 (0.60-1.70) 0.42 (0.23-0.87) Hyperlipidaernic (n = 26) 5.90 (5.30-7.60)* 1.95 (0.90-7.50)* 0.96 (0.38-6.98)* *P < 0.001. Comparison with normolipidaemic group, Mann-Whitney U-test. There was a significant correlation between triglyceride and vitamin K~ (r = 0.62; P < 0.001) but no correlation between cholesterol and vitamin K~ (r= 0.16; P> 0.05) using regression analysis. Conclusions: Plasma lipids must be considered in studies of assessment of vitamin K status using plasma concentration.