Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Lack of Effect of L-Carnitine Supplementation on Weight Gain in Very Preterm Infants

Journal of Perinatology volume 25, pages 470–477 (2005)Cite this article

Abstract

OBJECTIVE

Carnitine transfer across the placenta occurs predominantly during the third trimester. Unless L-carnitine is provided, very preterm infants develop carnitine deficiency. Although breast milk and infant formulas contain L-carnitine, parenteral nutrition solutions do not routinely provide L-carnitine. We hypothesized that prolonged L-carnitine supplementation in very preterm infants would improve weight gain and shorten length of stay in the hospital.

STUDY DESIGN

The study was a double-blind parallel placebo-controlled randomized clinical trial. Eligible patients were <29 weeks of gestation, <72 hours of age, and did not have a potentially life-threatening congenital malformation or hereditary metabolic disorder. Patients were stratified by gestational age (23 to 256/7 and 26 to 286/7 weeks), and randomized to receive, either L-carnitine at a dose of 50?μmol/kg/day, or placebo. Carnitine was provided intravenously until the infants tolerated 16?ml/day of feeds. The sample size was calculated to have 80% power to detect a 10% increase in weight gain from birth until 36 weeks of postmenstrual age or discharge from the hospital. Secondary outcome variables included food efficiency (defined as weight gain divided by caloric intake), weight gain at 4 weeks of age, time to regain birth weight and length of stay.

RESULTS

Among the 63 infants enrolled in the trial, 32 were randomized to L-carnitine and 31 to placebo. L-Carnitine supplementation did not significantly affect average daily weight gain from birth until 36 weeks or hospital discharge, or any of the secondary outcome variables.

CONCLUSION

Prolonged supplementation of L-carnitine did not improve long-term weight gain in very preterm infants.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Putet G . Lipid metabolism of the micropremie. Clin Perinatol 2000;27:57–69.

    Article  CAS  Google Scholar 

  2. Scaglia F, Longo N . Primary and secondary alterations of neonatal carnitine metabolism. Semin Neonatol 1999;23:152–161.

    CAS  Google Scholar 

  3. Pons R, Darryl C, De Vivo DC . Primary and secondary carnitine deficiency syndromes. J Child Neurol 1995;10(Suppl 2):S8–S24.

    Google Scholar 

  4. Melegh B . Carnitine supplementation in the premature. Biol Neonate 1990;58(Suppl 1):93–106.

    Article  Google Scholar 

  5. Smith RB, Sachan DS, Plattsmier J, Feld N, Lorch V . Plasma carnitine alterations in premature infants receiving various nutritional regimes. J Parenter Enteral Nutr 1988;12:37–42.

    Article  CAS  Google Scholar 

  6. Penn D, Ludwigs B, Schmidt-Sommerfeld E, Pascu F . Effect of nutrition on tissue carnitine concentrations in infants of different gestational ages. Biol Neonate 1985;47:130–135.

    Article  CAS  Google Scholar 

  7. Cederblad G, Svenningsen N . Plasma carnitine and breast milk carnitine intake in premature infants. J Pediatr Gastroenterol Nutr 1986;5:616–621.

    Article  CAS  Google Scholar 

  8. Schmidt-Sommerfeld E, Penn D, Wolf H . Carnitine deficiency in premature infants receiving total parenteral nutrition: effect of L-carnitine supplementation. J Pediatr 1983;102:931–935.

    Article  CAS  Google Scholar 

  9. Coran AG, Drongowski RA, Baker PJ . The metabolic effects of oral L-carnitine administration in infants receiving total parenteral nutrition with fat. J Pediatr Surg 1985;20:758–764.

    Article  CAS  Google Scholar 

  10. Melegh B, Kerner J, Sándor A, Vincellér M, Kispál G . Oral L-carnitine supplementation in low birth weight newborns: a study on neonates requiring combined parenteral and enteral nutrition. Acta Paediatr Hung 1986;27:253–258.

    CAS  PubMed  Google Scholar 

  11. Helms RA, Whitington PF, Mauer EC, Catarau EM, Christensen ML, Borum PR . Enhanced lipid utilization in infants receiving oral L-carnitine during long-term parenteral nutrition. J Pediatr 1986;109:984–988.

    Article  CAS  Google Scholar 

  12. Larsson R, Orlegård R, Ljung BML, Niklasson A, Rubensson A, Cederblad G . Parenteral nutrition in preterm neonates with and without carnitine supplementation. Acta Anaesthesiol Scand 1990;34:501–505.

    Article  CAS  Google Scholar 

  13. Helms R, Mauer EC, Hay Jr WW, Christensen ML, Storm MC . Effect of intravenous L-carnitine on the growth parameters and fat metabolism during parenteral nutrition in neonates. J Parenter Enteral Ntr 1990;14:448–453.

    Article  CAS  Google Scholar 

  14. Bonner CM, DeBrie KL, Hug G, Landigran E, Taylor BJ . Effect of parenteral L-carnitine supplementation on fat metabolism and nutrition in premature neonates. J Pediatr 1995;126:287–292.

    Article  CAS  Google Scholar 

  15. Sulkers EJ, Lafeber HN, Degenhart HJ, Przyrembel H, Scholtzer E, Sauer PJJ . Effects of high carnitine supplementation on substrate utilization in low-birth-weight infants receiving total parenteral nutrition. Am J Clin Nutr 1990;52:889–894.

    Article  CAS  Google Scholar 

  16. Shortland GJ, Walter JH, Stroud C, Fleming PJ, Speidel BD, Marlow N . Randomized controlled trial of L-carnitine as a nutritional supplement in preterm infants. Arch Dis Child Fetal Neonatal Ed 1998;78:F185–F188.

    Article  CAS  Google Scholar 

  17. Esteban N, Gopalareddy VG, Singh D . Total parenteral nutrition and carnitine supplementation practices in premature neonates. A national survey. Pediatr Res 2001;49:398A.

    Google Scholar 

  18. O’Donnell J, Finer NN, Rich W, Barshop BA, Barrington KJ . Role of L-carnitine in apnea of prematurity: a randomized, controlled trial. Pediatrics 2002;109:622–626.

    Article  Google Scholar 

  19. Whitfield J, Smith T, Sollohub H, Sweetman L, Roe CR . Clinical effects of L-carnitine supplementation on apnea and growth in very low birth weight infants. Pediatrics 2003;111:477–482.

    Article  Google Scholar 

  20. Thomas JR, Nelson JK, Thomas KT . A generalized rank-order method for nonparametric analysis of data from exercise science: a tutorial. Res Q Exerc Sport 1999;70:11–23.

    Article  CAS  Google Scholar 

  21. Hollander M, Wolfe DA . Comparing two success probabilities. In: Hollander M, Wolfe DA: Nonparametric Statistical Methods. 2nd ed. New York: John Wiley & Sons, Inc.; 1999. p. 458–494.

    Google Scholar 

  22. Borum PR . Carnitine in neonatal nutrition. J Child Neurol 1995;10(Suppl 2):S25–S31.

    PubMed  Google Scholar 

  23. Cairns PA, Stalker DJ . Carnitine supplementation of parenterally fed neonates (Cochrane review). The Cochrane Database of Systematic Reviews 2000, Issue 4. Art. No.: CD000950. DOI: 10.1002/14651858.CD000950.

  24. Crill CM, Storm MC, Wang B, et al. Carnitine supplementation in premature neonates increases plasma total carnitine concentrations (TCC). J Parenter Enteral Nutr 1999;23:S14.

    Google Scholar 

  25. Storm MC, Crill CM, Helms RA . Rapid return to birth weight in premature infants receiving parenteral and enteral nutrition supplemented with carnitine. J Parenter Enteral Nutr 2003;27:S18–S19.

    Google Scholar 

  26. Seidner SR, Chen YQ, Oprysko PR, et al. Combined prostaglandin and nitric oxide inhibition produces anatomic remodeling and closure of the ductus arteriosus in the premature newborn baboon. Pediatr Res 2001;50:365–373.

    Article  CAS  Google Scholar 

  27. Mutomba MC, Yuan H, Konyavko M, et al. Regulation of the activity of caspases by L-carnitine and palmitoylcarnitine. FEBS Lett 2000;478:19–25.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

Preliminary results were presented at the New York Perinatal Society, New York, NY, 5/28/02, at the Annual Meeting of the Eastern Society for Pediatric Research, Old Greenwich, CT, 3/23/03, and at the Annual Meeting of the Society for Pediatric Research at Seattle, WA, 5/6/03. We thank all the parents for allowing their babies to participate in this study, the personnel of the pharmacy and the neonatal intensive care unit at Weiler Hospital for their help in conducting the trial. We thank the attendings and fellows, neonatal nurse practitioners, family nurse practitioner and physician assistants who helped recruit patients and conduct the trial. We thank all members of the IRB who participated in the DSMB for this study: Katherine Freeman, MPH, Morri Markowitz, MD, Shlomo Shinnar, MD and Mark Sinnett, PharmD. We also thank Ruth E.K. Stein, MD and Andrew D. Racine, MD for reviewing the first version of the manuscript.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY, USA

    Sumati Pande MD, Luc P Brion MD, Deborah E Campbell MD & Nora V Esteban-Cruciani MD

  2. Department of Pharmacy, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY, USA

    Yvonne Gayle PharmD

  3. Saint Vincent Catholic Medical Center, New York, NY, USA

    Sumati Pande MD

Authors
  1. Sumati Pande MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luc P Brion MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deborah E Campbell MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yvonne Gayle PharmD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nora V Esteban-Cruciani MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pande, S., Brion, L., Campbell, D. et al. Lack of Effect of L-Carnitine Supplementation on Weight Gain in Very Preterm Infants. J Perinatol 25, 470–477 (2005). https://doi.org/10.1038/sj.jp.7211334

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211334

This article is cited by

Search

Advanced search

Quick links