Nitrogen metabolism in preterm infants fed human donor breast milk: the possible essentiality of glycine.

Nitrogen metabolism was studied in three preterm infants (mean gestation 32 wk) by the method of consecutive metabolic balance. The absorption and retention of nitrogen from breast milk was measured, and protein turnover, synthesis, and breakdown were calculated from isotopic plateau of urinary urea and ammonia using an intermittent oral administration of 15N-glycine. Weight gain and nitrogen retention were compared with the weight gain and nitrogen accumulated for a foetus of equivalent gestational age in utero. The average composition of the milk was 289 +/- 19 KJ dl-1 and 1.44 +/- 24 g protein dl-1. The intake of energy was 572 +/- 61 KJ kg-1 day -1 and of nitrogen 447 +/- 99 mg kg-1 day-1. Stool output of nitrogen was 100 +/- 32 mg kg-1 day-1 giving an absorption of 348 +/- 78 mg kg-1 day-1, as urinary excretion was 91 +/- 17 mg kg-1 day-1 retained nitrogen was 256 +/- 71 mg kg-1 day-1, or 56% of intake. The specific weight gain was 15.6 +/- 2.6 g kg-1 day-1 and 53% of this comprised lean tissue (range 34 to 89%). In all but one study the postnatal retention of nitrogen fell far short of calculated in utero accumulation. The results of protein turnover were surprising. In six of the eight studies urinary urea failed to become enriched at all. Protein turnover calculated from the ammonia plateau was 1.94 +/- 0.54 g nitrogen kg-1 day-1, synthesis 10.9 +/- 3.4 g protein kg-1 day-1 and breakdown 9.3 +/- 3.4 g protein kg-1 day-1. It is concluded that the amino acid composition of breast milk may be inappropriate for supporting rates of lean tissue deposition equivalent to in utero accumulation.