## 2 Provision of Energy and Macronutrients in Pediatric Patients on PN
### Effects on Growth and Nutritional Status
Additionally, available evidence suggests that adequate taurine provision may prevent cholestasis in newborn infants [117; 119]. According to ESPGHAN/ESPEN/ESPR guidelines [50], taurine should be part of amino acid solutions for administration to the pediatric age group. \begin{table}
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\begin{tabular}{c} Long-term PN \\ - \\ Venimolact or  
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\begin{tabular}{c c c c c c c c c} \hline \hline
**Study** & \begin{tabular}{c} **Design** \\ **Number of** \\ **Patients (N)** \\ \end{tabular}  & **Patients** & **Intervention** & **Control** & \begin{tabular}{c} **Amino Acid Dose** \\ **(g/kg BW/day)** \\ \end{tabular}  & **In Line with** & **FN Duration** & **Main Outcomes** \\ \hline  & & & & & & & No abnormalities in AA concentrations. \\  & & & & & & & & - & Vanimidact: THE levels significantly \\  & & & & & & & lower at day 1 and \\  & & & PN with & \(1.8\pm 0.2\) at day 1 & & & & day 3 and higher \\ [PERSON] et. al. & Controlled study & \begin{tabular}{c} [PERSON] infants \\ requiring PN \\ 0-4 days \\ \end{tabular}  & \ \begin{tabular}{c} PN with \\ Vanimidact \\ (n = 15) \\ \end{tabular}  &
\begin{tabular}{c} Vanimidact \\ Van  
In 1989, [PERSON] et al. reported results from the first published study comparing Vamino-lact in parenterally fed surgical newborn infants and infants/toddlers to a conventional adult amino acid solution based on the amino acid pattern of egg protein (Vamin) [126]. Vaminolact was initiated at 0.5 g amino acid/kg BW/day and advanced to a maximum of 2.5 g amino acid/kg/day during the 6-day study period. Plasma concentrations of all amino acids except threonine, lysine, histidine, and cysteine/cystine were closer to the reference plasma amino acid pattern of breast-fed infants than with the adult amino acid solution. In particular, infants receiving Vaminolact had a reduced risk of developing hyperphenylalaninemia and hypotyrosinemia, which have been associated with neurotoxicity in parenterally fed newborn infants [127]. From this short-term study, no significant differences in growth or nitrogen retention were seen between the two groups and no hematological or biochemical measurements changed significantly in either group. The authors concluded that Vaminolact would be likely to lessen the risk of neurotoxicity resulting from amino acid imbalance [126]. In a subsequent study comparing these two amino acid solutions (Vaminolact vs. Vamin) in critically ill newborn infants, [PERSON] et al. found that taurine levels recovered more rapidly with Vaminolact (n.s. ), while phenylalanine levels were significantly lower at day 1 and day 3. Moreover, the administration of Vaminolact at a mean dose of 2.3 g amino acids/kg BW/day from day 3 for a mean total duration of 12 days also resulted in substantially improved nitrogen balance when compared to the adult amino acid solution [125]. A clinical study involving hospitalized infants recovering from severe malnutrition receiving Vaminolact as part of total PN showed a body weight gain after 28 days of \(110\pm 5\%\) of optimal weight gain for age. In this study, the mean non-protein energy intake from PN was 104.3 \(\pm\) 8.0 kcal/kg BW/d with a mean PNDI of 210 \(\pm\) 20%. Authors concluded that a non-protein energy intake twice the resting energy expenditure was optimal to achieve the targeted body weight gain in this population of malnourished infants on TPN [14]. A retrospective study by [PERSON] [13] investigated parameters of growth and nutritional status among infants/toddlers and children on HPN receiving Vaminolact or a similar amino acid solution adapted to the specific requirements of the infants (Primene) at a mean dose of 2.9 g amino acids/kg BW/day for a mean duration of 1.9 years [14].