Isoleucine, Leucine, Valine and Tryptophan Requirements in TPN Fed Neonates

The study is based on the carbon oxidation protocol. Each baby will receive one or two levels of either isoleucine or leucine or valine or tryptophan. Each level will be assessed over a two- day period.

On day 1: each baby will receive a standard pediatric amino acid solution, Primene used in the NICU and L-[1-13C]Na Bicarbonate will be given to measure carbon dioxide production.

On day 2: he/she will receive the appropriate TPN Test Solution made up of the appropriate Bulk Amino Acid solution (for Isoleucine/ Leucine/ Valine/ Tryptophan Studies) with a different amount of the amino acid being investigated. To see how these amino acids are used in the body the investigators will add a small amount (calculated based on the body weight of the baby) of the amino acid L-[1-13C]phenylalanine to the amino acid solution. Breath and urine will be collected from the baby to study the oxidation of the L -[1-13C]phenylalanine. The investigators will take 2 x 0.75 ml blood to measure plasma amino acid concentration. The investigators will aim to coordinate blood taking with routine blood work done for clinical monitoring.

Inclusion criteria

• Stable preterm babies that are growing and fully TPN fed (at least 90% of calories and protein).
• TPN providing adequate calories and protein as determined by attending physician and dietitian.
• Babies born ≥ 28 weeks gestation,
• ≤ 28 days chronological age at the time of the study,
• Birth weight and length appropriate for gestational age,
• Medically stable as determined by normal blood results and lack of a fever or infection,
• At least 3 days after surgery, if the baby had a surgery

Exclusion criteria

• Babies on mechanical ventilation, on low flow oxygen and CPAP.
• Small for gestational age,
• On medications known to affect protein and amino acid metabolism,
• Documented infection, fever
• Unstable medical condition
• Receiving enteral feeding providing > 10% of protein intake