***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background : We have shown that increasing protein intake using a st and ardized , concentrated , added macronutrients parenteral ( SCAMP ) nutrition regimen improves head growth in very preterm infants ( VPIs ) compared with a control parenteral nutrition ( PN ) regimen .  VPIs are at risk of conditionally essential amino acid ( CEAA ) deficiencies because of current neonatal PN amino acid ( AA ) formulations . We hypothesized that the SCAMP regimen would prevent low plasma levels of CEAAs . Aim : To compare the plasma AA profiles at approximately day 9 of life in VPIs receiving SCAMP vs a control PN regimen . Methods : VPIs ( < 29 weeks ’ gestation ) were r and omized to receive SCAMP ( 30 % more PN AA ) or a control regimen .  Data were collected to measure parenteral and enteral protein , energy , and individual AA intake and the first plasma AA profile . Plasma profiles of the 20 individual protogenic AA levels were measured using ion exchange chromatography . Results : Plasma AA profiles were obtained at median ( interquartile range [ IQR ] ) age of 9 ( 8–10 ) days in both SCAMP ( n = 59 ) and control ( n = 67 ) groups after r and omizing 150 VPIs . Median ( IQR ) plasma levels of individual essential AAs were higher than the reference population mean ( RPM ) in both groups , especially for threonine . SCAMP infants had higher plasma levels of essential AAs than did the controls . Median ( IQR ) plasma levels of glutamine , arginine , and cysteine ( CEAAs ) were lower than the RPM in both groups . Conclusion : Plasma AA levels in PN-dependent VPIs indicate there is an imbalance in essential and CEAA provision in neonatal PN AA formulations that is not improved by increasing protein intake BACKGROUND Glutamine is one of the most abundant amino acids in both plasma and human milk and may be conditionally essential in premature infants . However , glutamine is not provided by st and ard intravenous amino acid solutions . OBJECTIVE We assessed the effect of parenteral glutamine supplementation on plasma amino acid concentrations in extremely low-birth-weight infants receiving parenteral nutrition ( PN ) . DESIGN A total of 141 infants with birth weights of 401 - 1000 g were r and omly assigned to receive a st and ard intravenous amino acid solution that did not contain glutamine or an isonitrogenous amino acid solution with 20 % of the total amino acids as glutamine . Blood sample s were obtained just before initiation of study PN and again after the infants had received study PN ( mean intake : 2.3 + /- 1.0 g amino acids x kg(-1 ) x d(-1 ) ) for approximately 10 d. RESULTS Infants r and omly assigned to receive glutamine had mean plasma glutamine concentrations that increased significantly and were approximately 30 % higher than those in the control group in response to PN ( 425 + /- 182 and 332 + /- 148 micromol/L for the glutamine and control groups , respectively ) . There was no significant difference between the 2 groups in the relative change in plasma glutamate concentration between the baseline and PN sample s. In both groups , there were significant decreases in plasma phenylalanine and tyrosine between the baseline and PN sample s ; the decrease in tyrosine was greater in the group that received glutamine . CONCLUSIONS In extremely low-birth-weight infants , parenteral glutamine supplementation can increase plasma glutamine concentrations without apparent biochemical risk . Currently available amino acid solutions are likely to be suboptimal in their supply of phenylalanine , tyrosine , or both for these infants Objective : The primary aim of this study was to determine if an association exists between amino-acid levels and development of cholestasis . The secondary aim of our amino-acid dose comparison trial was to identify factors associated with the development of prolonged cholestatic jaundice . Study Design : We compared demographic characteristics and amino-acid levels in neonates who developed cholestasis with those who did not . Parenteral-associated cholestatic liver disease was defined as a direct serum bilirubin above 5 mg per 100 ml any time during the first 28 days after birth in neonates with no history of biliary atresia or viral hepatitis . We obtained filter paper blood spots for amino acid and acylcarnitine measurements on the day of r and omization and days 7 and 28 of age to identify a profile of values that could be used to identify neonates with evidence of abnormal liver function . Result : We enrolled 122 neonates in our study ; 13 ( 10.7 % ) developed cholestasis . Neonates who developed cholestasis were more immature , had lower birth weight , were exposed to parenteral nutrition for a longer period , had a higher cumulative dose of amino acids , were less often on enteral nutrition by day 7 of age , more often had a patent ductus arteriosus and severe intraventricular hemorrhage and were more commonly treated with steroids by 28 days of age . Amino acid and acylcarnitine values were not different for the two groups on the day of r and omization . On day 7 ( parenteral phase of nutrition ) , blood urea nitrogen , citrulline , histidine , methionine and succinyl carnitine were higher , and serine , glutamate and thyroxine levels were lower in the neonates who developed cholestasis than in who did not . Conclusion : Cholestasis remains an important complication of parenteral nutrition , and several clinical and biochemical factors may be helpful in identifying high-risk patients OBJECTIVES To examine the effect of supplemental glutamine ( 0.6 g.kg -1 .d -1 ) on whole body protein/nitrogen and glutamine kinetics in low birth weight ( LBW ) infants receiving parenteral nutrition in the immediate neonatal period . STUDY DESIGN Premature infants < or = 32 weeks gestation with a birth weight from 694 to 1590 g were r and omly assigned to either a glutamine-supplemented group ( n = 10 ) or to a control group ( n = 10 ) . Tracer isotope studies were performed when the infants were 6 to 7 days old and had been receiving an amino acid intake of approximately 3.0 g.kg -1 .d -1 for at least 3 days . Whole body glutamine and nitrogen kinetics were measured with [5 - 15N]glutamine , [2H5]phenylalanine , [ 1 - 13C , 15 N]leucine , [15N2]urea , and GC-mass spectrometry . RESULTS Supplemental glutamine was associated with a lower rate of appearance of glutamine ( P = .003 ) , phenylalanine ( P = .001 ) , and leucine C ( P = .003 ) . There was no significant difference in leucine N turnover , urea turnover and plasma cortisol , and C-reactive protein levels in the 2 groups . CONCLUSION Parenteral glutamine supplement in LBW infants was associated with lower whole-body protein breakdown . Because the decrease in whole body proteolysis is associated with protein accretion , parenteral glutamine supplement may be beneficial in selected population s of LBW infants Inadequate arginine intake has been suggested as an etiology for hyperammonemia in neonates on parenteral nutrition . We r and omized 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 less than 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 less than 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 Objective : To study the efficacy of early high doses parenteral nutrition ( PN ) versus early low dose with progressive increments PN regimens , we performed a prospect i ve r and omized study in very low birth-weight infants . Study design : Forty-one appropriate gestational age preterm infants with birth weights ranging from 750–1500 g were r and omly assigned into two groups . In Group 1 , infants started on 3.0 g/kg/day amino acids ( AA ) and 3 g/kg/day of 20 % lipid ; in Group 2 , AA and lipid were started on 1 g/kg/day , and advanced over 3 days to a maximum 3 g/kg/day . Blood sample s were obtained for AA concentrations before starting of the PN , and at the 7th and 14th days . Results : The  mean ( ±SD ) birth weight was 1335 g ( 240 ) , gestational age was 29.7 weeks ( 1.7 ) of the study group .  The mean body weight and head circumference was similar in the Group 1 and Group 2 at the 14th postnatal days . There was no difference in the blood levels of triglyceride , blood urea nitrogen , creatinine , ammonia , lactat and bicarbonate in the two groups . There was no significant difference in the concentrations of AA except for arginine and asparagine . On day 14 , the mean arginine concentrations were significantly higher and asparagine concentrations were lower in Group 2 . Conclusion : Although earlier more aggressive administration of AA and fat is not associated with any significant metabolic abnormalities , growth rates and plasma AA concentrations of the infants were similar to infants who AA and lipid given lower in the first day of life OBJECTIVES To determine whether supplementation with L -arginine reduces the incidence of all stages of necrotizing enterocolitis ( NEC ) in premature infants with birth weight < or = 1250 g and gestational age < or = 32 weeks . STUDY DESIGN In a r and omized , double-blind , placebo-controlled study , 152 premature infants were prospect ively , r and omly assigned to receive either supplemental L -arginine ( 1.5 mmol/kg per day ; n = 75 [ group A ] ) or placebo ( control group ; n = 77 [ group B ] ) with oral feeds/parenteral nutrition during the first 28 days of life . Nutrient intake , plasma ammonia , arginine , and amino acid concentrations were measured in all infants at days 3 , 14 , and 28 and at the time of diagnosis of NEC . RESULTS NEC developed in 5 infants in group A compared with 21 infants in group B ( P < .001 ) . Arginine intake and plasma arginine concentrations were similar in both groups at study entry and ( as expected ) increased in group A at days 14 and 28 . Plasma arginine concentrations were lower in both groups at time of diagnosis of NEC . No significant differences in maternal and neonatal demographics , nutrient intake , plasma ammonia and total and essential amino acid concentrations were present between the two groups . CONCLUSIONS Arginine supplementation ( 1.5 mmol/kg per day ) in premature infants reduces the incidence of all stages of NEC BACKGROUND Administration of high-dose parenteral amino acids ( AAs ) to premature infants within hours of delivery is currently recommended . This study compared the effect of lower and higher AA administration starting close to birth on short-term growth and neurodevelopmental outcomes at 18 - 24 months corrected gestational age ( CGA ) . METHODS Infants < 1250 g birth weight ( n = 168 ) were r and omly assigned in a blinded fashion to receive parenteral nutrition providing 1 - 2 g/kg/d AA and advancing daily by 0.5 g/kg/d to a goal of 4 g/kg/d ( st and ard AA ) or 3 - 4 g/kg/d and advancing to 4 g/kg/d by day 1 . The primary outcome was neurodevelopmental outcomes measured by the Bayley Scales of Infant and Toddler Development , Third Edition at 18 - 24 months CGA . Secondary outcomes were growth parameters at 36 weeks CGA among infants surviving to hospital discharge , serum bicarbonate , serum urea nitrogen , creatinine , AA profiles in the first week of life , and incidence of major morbidities and mortality . RESULTS No differences in neurodevelopmental outcome were detected between the high and low AA groups . Infants in the high AA group had significantly lower mean weight , length , and head circumference percentiles than those in the st and ard AA group at 36 weeks CGA and at hospital discharge . These differences did not persist after controlling for birth growth parameters , except for head circumference . Infants in the high AA group had higher mean serum urea nitrogen than the st and ard group on each day throughout the first week . CONCLUSION Current recommendations for high-dose AA starting at birth are not associated with improved growth or neurodevelopmental outcomes OBJECTIVES . The goal was to measure the effects of 2 distinct strategies for parenteral nutrition on  neonatal growth and blood amino acid profiles . METHODS . In a multicenter trial ( n 
    Output:
    
Future studies using AA solutions with arginine content of 17%-20 % and protein intakes of 3.5 - 4.0 g/kg per day may be needed to achieve higher plasma arginine concentrations