What is the recommended dosing for Aminoven (amino acid solutions) in neonates?

Aminoven Dosing in Neonates

For optimal neonatal outcomes, Aminoven (amino acid solution) should be dosed at 1.5 g/kg/day on the first postnatal day for preterm infants, increasing to 2.5-3.5 g/kg/day from day 2 onwards, while term infants should receive 1.5-3.0 g/kg/day. 1

Dosing Recommendations by Gestational Age

Preterm Infants

• Start amino acid supply on the first postnatal day with at least 1.5 g/kg/day to achieve an anabolic state (Level of Evidence 1++, Recommendation Grade A) 1
• From postnatal day 2 onwards, provide 2.5-3.5 g/kg/day of parenteral amino acids, accompanied by non-protein intakes >65 kcal/kg/day and adequate micronutrient intake (Level of Evidence 1+, Recommendation Grade A) 1
• Do not exceed 3.5 g/kg/day outside of clinical trials (Level of Evidence 2+) 1

Term Infants

• Administer a minimum amino acid intake of 1.5 g/kg/day to stable term infants to avoid negative nitrogen balance 1
• Maximum amino acid intake should not exceed 3.0 g/kg/day (Level of Evidence 1+, Recommendation Grade B) 1
• Consider withholding parenteral nutrition, including amino acids, for 1 week in critically ill term infants while providing micronutrients (Level of Evidence 1+, Recommendation Grade B) 1

Specific Amino Acid Requirements

• Bioavailable cysteine: 50-75 mg/kg/day should be administered to preterm neonates (Level of Evidence 1+, Recommendation Grade B) 1
• Tyrosine: At least 18 mg/kg/day for preterm infants (Level of Evidence 2++, Recommendation Grade B) 1
• Tyrosine: 94 mg/kg/day for term infants (Level of Evidence 1+, Recommendation Grade B) 1
• Taurine: Should be included in amino acid solutions for infants, though specific dosage limits are not firmly established (Level of Evidence 1, Recommendation Grade B) 1

Administration Guidelines

• Ensure adequate non-protein caloric intake of minimum 30-40 kcal per 1g amino acids to guarantee amino acid utilization 1
• Start amino acids as soon as possible after birth to avoid the "metabolic shock" caused by interruption of continuous feeding that occurs in utero 1
• Early amino acid administration results in increased protein synthesis without decreasing proteolysis 1

Monitoring and Safety Considerations

• Monitor for potential biochemical intolerances, particularly blood urea nitrogen levels, which may be elevated with higher amino acid intake 2
• Be aware that higher amino acid intake (>3.5 g/kg/day) has not been shown to improve neonatal growth and is associated with increased blood amino acid and urea nitrogen levels 3
• Lower intravenous amino acid intake (around 1.5 g/kg/day) may be preferred in supplementary parenteral nutrition of preterm infants to avoid plasma accumulation of amino acids 4

Special Considerations

• Arginine supplementation may be considered for prevention of necrotizing enterocolitis (NEC) in preterm infants (Level of Evidence 1, Recommendation Grade B) 5
• Glutamine should not be supplemented additionally in infants up to two years of age (Level of Evidence 1++, Recommendation Grade A) 1
• Higher amino acid intake has been associated with reduced incidence of postnatal growth failure and retinopathy of prematurity, though evidence quality is very low 2
• Positive protein balance can be achieved with approximately 1 g/kg/day of amino acids, while protein accretion requires around 3 g/kg/day 6

Common Pitfalls to Avoid

• Exceeding 3.5 g/kg/day in preterm infants, which may lead to amino acid imbalances without improving outcomes 1, 3
• Insufficient non-protein caloric intake, which can impair amino acid utilization 1
• Delaying amino acid administration beyond the first day of life, which can result in protein catabolism and negative nitrogen balance 1, 6
• Failure to adjust dosing based on clinical status (stable vs. critically ill) 1