Do Preemies Need Extra Carnitine? 

Pande S, Brion LP, Campbell DE, et al. Lack of Effect of L-Carnitine Supplementation on Weight Gain in Very Preterm Infants. J Perinatol (July 2005) 25: 470-477.

Objective: Carnitine transfer across the placenta occurs predominantly during the third trimester. Unless L-carnitine is provided, very preterm infants develop carnitine deficiency. Although breast milk and infant formulas contain L-carnitine, parenteral nutrition solutions do not routinely provide L-carnitine. We hypothesized that prolonged L-carnitine supplementation in very preterm infants would improve weight gain and shorten length of stay in the hospital.

Study Design: The study was a double-blind parallel placebo-controlled randomized clinical trial. Eligible patients were <29 weeks of gestation, <72 hours of age, and did not have a potentially life-threatening congenital malformation or hereditary metabolic disorder. Patients were randomized to receive either L-carnitine at a dose of 50 mol/kg/day, or placebo. Carnitine was provided intravenously until the infants tolerated 16 ml/day of feeds.

Results:  Among the 63 infants enrolled in the trial, 32 were randomized to L-carnitine and 31 to placebo. L-Carnitine supplementation did not significantly affect average daily weight gain from birth until 36 weeks or hospital discharge, or any of the secondary outcome variables.

Conclusion:  Prolonged supplementation of L-carnitine did not improve long-term weight gain in very preterm infants.

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Comments: This is now the fourth randomized, controlled trial that failed to show any benefit to carnitine supplementation in premature infants.  The supplemented infants did not grow better and they did not go home any sooner. So what’s the harm of just supplementing with carnitine anyway?    While not statistically significant, the carnitine group showed a trend toward increased mortality (16% vs. 10%), chronic lung disease (57% vs. 43%), severe IVH (28% vs. 19%), and laser surgery for ROP (19% vs. 14%).  Most concerning, the infants who were supplemented with carnitine required significantly more PDA ligations due to failure to respond to indomethacin (36% vs. 0%, p = 0.046).  My opinion: we have no evidence of benefit of carnitine supplementation in premature infants, and plenty of potential risks.  Pending further studies, it seems prudent to omit the carnitine from their TPN. ABK.