This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.ABSTRACTSick neonates, including those with congenital heart disease, usually require Total Parenteral Nutrition (TPN) during their first several days of life until their ability to tolerate enteral feeds is well established. These infnats, as well as those born prematurely, are at risk of disturbed glucose metabolism and inadequate energy supplejentation. In an effort to prevent hypoglycemia and to provide a sufficient energy intake, some of these neonates are routinely receiving glucose at rates about twice their normal glucose turn over rate (: 6 mg/kg/min.) This regimen results in a frequently occurrence of hyperglycemia, particularly in premature and sick infants. We do not know how changing the glucose infusion rate affects the glucose metabolism and the blood glucose levels innewborns with congenitalheart disease. The purpos of this project is to determine the effects of different glucose infusion rates on glucose, lipid, and protein metabolism innewborn infants with congenital heart disease. It is important for us to learn about the physiology of glucose metabolism in these sick neonates to enable us to formulate an adequate parenteral nutrition that renders these infants normoglycemic and provide them with a sufficient energy intake.HYPOTHESISHyperglycemia is more likely to occur during routine TPN (usually providing glucose at rates corresponding about twice the normal glucose turnover rate) than during a TPN providing glucose at 6 mg/kg/min (normal glucose turnover rate).Newborn infants with congenital heart disease are able to maintain normoglycemia during a 6mg/kg/min glucose infusion rate (while maintaining the infusion rates of parenteral lipids and amino acids unchanged).Glucose production, particularly gluconeogenesis, is not completely suppressed in infants with contential heart disease while receiving a routine TPN providing glucose at twice normal turnover rate.Whole-body protein synthesis is reduced in sick infants receiving TPN providing at 6mg/kg/min.
SPECIFIC AIMS The purpose of this study is to determine the effects of routine TPN (providing glucose oat about twice normal turnover rates), and of reducing the infusion rate of glucose to correspond to the normal glucose turnover (while maintaining the infusion rates of paenteral lipids and amino acids unchanged) on glucose, lipid and protein metabolism in infants with congenital heart disease using established Stable Isotope-GCMS techniques. This will allow us to determine the metabolic effects of glucose infusion rate in sick newborn infants with congenital heart disease.
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