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Journal of Parenteral and Enteral Nutrition
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Clinical Trial

Hyperammonemia in Neonates Receiving Intravenous Nutrition

Daniel W. Thomas, M.D.

Gastroenterology Program and the Division of Neonatal and Respiratory Diseases, Childrens Hospital of Los Angeles, and the Department of Pediatrics, University of Southern California, School of Medicine, Los Angeles, California

Frank R. Sinatra, M.D.

Gastroenterology Program and the Division of Neonatal and Respiratory Diseases, Childrens Hospital of Los Angeles, and the Department of Pediatrics, University of Southern California, School of Medicine, Los Angeles, California

Shirley L. Hack, R.D.

Gastroenterology Program and the Division of Neonatal and Respiratory Diseases, Childrens Hospital of Los Angeles, and the Department of Pediatrics, University of Southern California, School of Medicine, Los Angeles, California

Thomas M. Smith, M.S.

Gastroenterology Program and the Division of Neonatal and Respiratory Diseases, Childrens Hospital of Los Angeles, and the Department of Pediatrics, University of Southern California, School of Medicine, Los Angeles, California

Arnold C.G. Platzker, M.D.

Gastroenterology Program and the Division of Neonatal and Respiratory Diseases, Childrens Hospital of Los Angeles, and the Department of Pediatrics, University of Southern California, School of Medicine, Los Angeles, California

Russell J. Merritt, M.D., PH.D.

Gastroenterology Program and the Division of Neonatal and Respiratory Diseases, Childrens Hospital of Los Angeles, and the Department of Pediatrics, University of Southern California, School of Medicine, Los Angeles, California

Inadequate arginine intake has been suggested as an etiology for hyperammonemia in neonates on parenteral nutrition. We randomized 26 nonasphyxiated neonates to receive amino acid solutions containing either 3.6 or 10.4% of total nitrogen as arginine when intravenous nutrition (IVN) therapy was initiated. Neonates in both amino acid solution study groups were observed to have significantly elevated blood ammonia (BA) concentrations during IVN (p < 0.01) as compared to pre-IVN levels. Blood ammonia concentrations tended to be higher in infants receiving the 3.6% arginine amino acid solution. Septic infants were at particular risk for hyperammonemia as compared to nonseptic patients (p < 0.025). Other clinical parameters including birth weight, gestational age, oxygen requirements, enteral nutritional intake, congenital anomalies, and heart disease did not appear to be related to BA concentration.

Journal of Parenteral and Enteral Nutrition, Vol. 6, No. 6, 503-506 (1982)
DOI: 10.1177/0148607182006006503
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[Abstract] [Full Text] [PDF]