Among infants supplemented with carnitine , there was no evidence of effect on weight gain , lipid utilization or ketogenesis .
REVIEW ER 'S CONCLUSIONS We found no evidence to support the routine supplementation of parenterally fed neonates with carnitine
BACKGROUND Carnitine , a quaternary amino acid , plays an important role in the oxidation of long chain fatty acids .
Both breast milk and infant formulas contain carnitine .
However , it is not routinely provided in parenteral nutrition solutions .
Non supplemented parenterally fed infants have very low tissue carnitine levels .
The clinical significance of this is uncertain .
Carnitine deficiency may be an etiological factor in the limited ability of premature babies to utilize parenteral lipid .
In vitro studies have suggested that fatty acid oxidation is impaired when the tissue carnitine levels fall below 10 % of normal .
Therefore relative carnitine deficiency may impair fatty acid oxidation , thus reducing the available energy and impairing growth .
OBJECTIVES The primary aim of this review is to determine whether carnitine supplementation of parenterally fed neonates will improve weight gain .
The secondary aims are to determine the effect on lipid tolerance and ketogenesis .
Are Bilirubin and Plasma Lipid Profiles of Premature Infants Dependent on the Lipid Emulsion Infused?
Summary The effect of a lipid emulsion containing longchain triglycerides ( LCT ) and supplemented with L-carnitine on plasma lipids and bilirubin in premature neonates on total parenteral nutrition was compared to that of lipid emulsions containing either LCT or a mixture of LCT and medium-chain triglycerides ( MCT ) . In a double-blind r and omized study 49 premature neonates received one of the three fat emulsions , given intravenously , over 16–20 h daily for 6 days . Plasma carnitine levels increased significantly in the supplemented group only ; the addition of carnitine did not seem to affect any of the parameters studied . Mean plasma triglycerides rose by 193 and 199 % in the carnitine-supplemented and the LCT groups , respectively , and by 314 % in the MCT/LCT group . On the sixth day of the study free fatty acids were significantly higher in the MCT/LCT group than in the other two groups . Plasma phospholipids and free cholesterol increased ( p < 0.05 ) progressively in all groups and were correlated ( r = 0.74 , p < 0.001 ) . At the end of the 6-day study all groups showed a similar decline in free and total bilirubin levels despite the significant increase in plasma lipids and free fatty acids result ing from the stepwise increase in lipid load . No correlation was found between free fatty acids and free bilirubin . Since hyperbilirubinemia and hypertriglyceridemia appear to be clinical ly independent factors , the infusion of lipids should not be withheld from jaundiced infants on total parenteral nutrition
Among infants supplemented with carnitine , there was no evidence of effect on weight gain , lipid utilization or ketogenesis .
REVIEW ER 'S CONCLUSIONS We found no evidence to support the routine supplementation of parenterally fed neonates with carnitine
BACKGROUND Carnitine , a quaternary amino acid , plays an important role in the oxidation of long chain fatty acids .
Both breast milk and infant formulas contain carnitine .
However , it is not routinely provided in parenteral nutrition solutions .
Non supplemented parenterally fed infants have very low tissue carnitine levels .
The clinical significance of this is uncertain .
Carnitine deficiency may be an etiological factor in the limited ability of premature babies to utilize parenteral lipid .
In vitro studies have suggested that fatty acid oxidation is impaired when the tissue carnitine levels fall below 10 % of normal .
Therefore relative carnitine deficiency may impair fatty acid oxidation , thus reducing the available energy and impairing growth .
OBJECTIVES The primary aim of this review is to determine whether carnitine supplementation of parenterally fed neonates will improve weight gain .
The secondary aims are to determine the effect on lipid tolerance and ketogenesis .