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DR. ADAMKiN: The early initiation of amino acids is very important in preventing specific metabolic abnormalities. We have learned from a number of papers, including in this issue’s eNeonatal Review from Richard Ehrenkranz, the importance of energy the first week of life.3 That study showed less morbidity and mortality related to more energy the first week of life in these babies. Another study correlated energy in the first week of life in babies of this size having higher cognitive scores out to 30 months of life. So the first week of life is a critical window for optimizing early nutritional support based on recent recommendations in very low birth weight babies from Senterre and Rigo. 1 MR. BUSKER: And second: the role of parenteral amino acids in glycemic control and of lipids with lung disease in very low birth weight infants. DR. ADAMKiN: We know that the amino acids turn on insulin. Insulin will allow the baby to be more glucose tolerant, and the baby who is more glucose tolerant will be able to receive more energy and more energy in the first week of life equals better outcome. The insulin also keeps potassium in the cell and prevents nonoliguric hyperkalemia, which can be life threatening. So early amino acids have very important roles. The use of lipids is somewhat more controversial with lung disease, but we ought to at least be aware that the possibility exists that the lipid dosage may have to be modified in babies with lung disease because of the possibility of lipid adminstration being associated with pulmonary vasoconstriction and decreasing oxygenation. MR. BUSKER: And finally: the use of donor human milk and the need for fortification in very low birth weight infants. DR. ADAMKiN: It’s clear that these extremely low birth weight babies need human milk — own mother’s milk first choice, donor human milk second choice — because it improves outcomes, decreases morbidities, and prevents necrotizing enterocolitis and infection. However, from a growth standpoint, the levels of protein, calcium, and phosphorus are inadequate in human milk and therefore the human milk must be fortified to provide the benefits of growth along with all the other important things that human milk does to improve the outcome for these babies. MR. BUSKER: Dr. David Adamkin from the University of Louisville, thank you for participating in this eNeonatal Review podcast. DR. ADAMKiN: Thank you very much, and I hope our audience can benefit from the information provided. Thank you. MR. BUSKER: This podcast is presented in conjunction with the eNeonatal Review Newsletter, a peer-reviewed literature review certified for CME/CE credit, emailed monthly to clinicians treating patients in the NICU. This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education, through the joint sponsorship of the Johns Hopkins University School of Medicine and The Institute for Johns Hopkins Nursing. The Johns Hopkins University School of Medicine is accredited by the ACCME to provide continuing medical education for physicians. For physicians, the Johns Hopkins University School of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in this activity. The Institute for Johns Hopkins Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Institute for Johns Hopkins Nursing and the American Nurses Credentialing Center do not endorse the use of any commercial products discussed or displayed in conjunction with this educational activity. For nurses, this 0.5 contact hour Educational Activity is provided by The Institute for Johns Hopkins Nursing. Each podcast carries a maximum of 0.5 contact hour. This educational resource is provided without charge, but registration is required. To register to receive eNeonatal Review via e-mail, please go to our website, www.eneonatalreview.org. eNeonatal Review Podcast Transcript, Volume 9: Issue 14 6
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of names of the Johns Hopkins University School of Medicine and The Institute for Johns Hopkins Nursing implies review of educational format, design, and approach. Please review the complete prescribing information for specific drugs, combinations of drugs, or use of medical equipment, including indication, contraindications, warnings, and adverse effects, before administering therapy to patients. eNeonatal Review is supported by educational grants from Abbott Nutrition, Cornerstone Pharmaceuticals, Ikaria, and Mead Johnson Nutrition. Thank you for listening. This program is copyright 2013, with all rights reserved, by the Johns Hopkins University School of Medicine and The Institute for Johns Hopkins Nursing. eNeonatal Review Podcast Transcript, Volume 9: Issue 14 7
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