Carnitine supplementation increases serum concentrations of free carnitine and total acylcarnitine in preterm neonates: A retrospective cohort study

Document Type

Journal Article

Publication Date



JPEN. Journal of parenteral and enteral nutrition




Preterm; free carnitine; total acylcarnitine; triglyceride


OBJECTIVE: To determine the efficacy of the American Society for Parenteral and Enteral Nutrition's recommended carnitine dosage of 5mg/kg/day in maintaining normal serum free carnitine and total acylcarnitine levels in preterm neonates receiving parenteral nutrition. STUDY DESIGN: A retrospective cohort study was conducted on neonates born <30 weeks gestation and <1250gm, comparing those who received carnitine supplementation to controls who did not receive supplementation. Free carnitine and total acylcarnitine data were collected from routine newborn screens in the first days of life, and again once full feeds were reached. Univariate analysis was performed and those factors that were significantly different between the two groups were adjusted for using mixed effects analysis. RESULTS: There were 108 supplemented and 45 unsupplemented neonates in the study. At baseline, free carnitine (19.8±3.3 vs. 18.9±3.7µmoles/L, p=0.53) and total acylcarnitine (26.6±5.1 vs. 22.5±7.1µmoles/L, p=0.11) were similar between the two groups. At full enteral feeds, compared to unsupplemented group, supplemented infants had significantly higher free carnitine (27.1±16.4 vs.17.1±8.5µmoles/L, p<0.001) and total acylcarnitine (30.3±11.5 vs.20.2±10.1µmoles/L, p<0.001). None of the supplemented neonates developed biochemical carnitine deficiency as compared to 18% in the unsupplemented group (p<0.001). No difference was observed in time to reach full lipid provision and there were no differences in the change in the triglyceride levels from baseline to the time on full PN lipid provision (p=0.39). CONCLUSION: Preterm neonates routinely supplemented with parenteral carnitine at 5 mg/kg/day demonstrated higher free carnitine and total acylcarnitine levels at full feeds, with none developing biochemical carnitine deficiency. This article is protected by copyright. All rights reserved.