Serum choline in extremely preterm infants declines with increasing parenteral nutrition

• DOI: 10.1007/s00394-020-02312-2
• Publication Date: 2020-06-25T20:03:36Z
• Authors: Anders K. Nilsson; Anders Pedersen; Daniel Malmodin; Anna-My Lund; Gunnel Hellgren; Chatarina Löfqvist; Ingrid Hansen Pupp; Ann Hellström
• Keywords: Betaine; 0301 basic medicine; Parenteral Nutrition; 03 medical and health sciences; Infant, Extremely Premature; Infant, Newborn; Humans; Infant; Original Contribution; Prospective Studies; Choline; 3. Good health

Abstract Purpose Choline is an essential nutrient for fetal and infant growth and development. Parenteral nutrition used in neonatal care lack free choline but contain small amounts of lipid-bound choline in the form of phosphatidylcholine (PC). Here, we examined the longitudinal development of serum free choline and metabolically related compounds betaine and methionine in extremely preterm infants and how the concentrations were affected by the proportion of parenteral fluids the infants received during the first 28 postnatal days (PNDs).

Methods This prospective study included 87 infants born at gestational age (GA) < 28 weeks. Infant serum samples were collected PND 1, 7, 14, and 28, and at postmenstrual age (PMA) 32, 36, and 40 weeks. The serum concentrations of free choline, betaine, and methionine were determined by 1H NMR spectroscopy.

Results The median (25th–75th percentile) serum concentrations of free choline, betaine, and methionine were 33.7 (26.2–41.2), 71.2 (53.2–100.8), and 25.6 (16.4–35.3) µM, respectively, at PND 1. The choline concentration decreased rapidly between PND one and PND seven [18.4 (14.1–26.4) µM], and then increased over the next 90 days, though never reaching PND one levels. There was a negative correlation between a high intake of parenteral fluids and serum-free choline.

Conclusion Circulating free choline in extremely preterm infants is negatively affected by the proportion of parenteral fluids administered.

Trial registration ClinicalTrials.gov Identifier NCT02760472, April 29, 2016, retrospectively registered.