Early Parenteral Amino Acid Supplementation Reduces the Risk of Neonatal Hyperkalemia in Preterm Infants: Single-Center Retrospective Study.

Abstract

\n The incidence of neonatal hyperkalemia in preterm infants was high in the early 2000s. However, the prevalence has declined recently, and the reason for the decline remains unclear. The development of neonatal hyperkalemia can be influenced by suppression of insulin secretion due to hypercatabolism; thus, early parenteral amino acid supplementation, which is now widespread for nutritional management for preterm infants, may have contributed to the decline. We conducted a single-center, retrospective cohort study with 225 preterm infants inborn between 240/7 and 316/7 weeks of gestation during 2009–2018. We compared the incidence of neonatal hyperkalemia between those with or without early parenteral amino acid supplementation (initiated within 24 h after birth). We included 150 infants with early AA supplementation from the first day of life and 75 controls. The incidence of neonatal hyperkalemia was significantly lower in the AA group than the control group (2.7% vs 12.4%, p<0.05). In multivariate analysis, the risk of hyperkalemia increased with delivery at <28 weeks and decreased with AA supplementation (adjusted odds ratio 0.11; 95% confidence interval 0.02–0.56, p<0.01). In conclusion, early AA supplement from the first day of life might have a prophylactic effect on neonatal hyperkalemia in preterm infants.