Plasma choline in normal newborns, infants, toddlers, and in very-low-birth-weight neonates requiring total parenteral nutrition

Choline deficiency is associated with hepatic abnormalities in adult volunt eers and patients administered total parenteral nutrition (TPN). Preliminar y investigation has suggested that plasma-free choline concentration (PFCh) is greater in neonatal animals, including humans, than in adults. The aims of this study were to determine the normal PFCh and phospholipid-bound cho line concentration (PPLBCh) fur newborns, infants, and toddlers and to dete rmine the change during TPN. We also sought to determine the degree of feta l choline extraction, the relation between maternal and newborn plasma chol ine concentrations, and the relation between plasma choline status and norm al newborn length, weight, and gestational age. Blood samples were obtained from 104 full-term newborns in two centers (Ben Taub and Maimonides), 25 m others, 21 normal infants aged 20.3 +/- 11.8 wk, 12 normal infants aged 62. 3 +/- 3.9 wk, and 14 preterm infants (gestational age = 28.9 +/- 2.2 wk) wh o required TPN. The vein PFChs were 28.1 +/- 13.0 nmol/ml (Ben Taub) and 68 .1 +/- 16.9 nmol/ml (Maimonides). The artery PFChs were 27.1 +/- 13.0 nmol/ mL (Ben Taub) and 57.9 +/- 11.6 nmol/ml (Maimonides). The vein PPLChs were 1004.7 +/- 246.6 nmol/mL (Ben Taub) and 1121.2 +/- 289.6 nmol/mL (Maimonide s). The artery PPLChs were 1065.7 +/- 469.3 nmol/mL (Ben Taub) and 1106.9 /- 285.8 nmol/mL (Maimonides). The vein-minus-artery differences for PFCh w ere 1.0 +/- 9.7 nmol/mL (Ben Taub) and 10.2 +/- 10.9 mmol/mL (Maimonides). The vein-minus-artery differences for PPLCh were -51.9 +/- 398.2 nmol/ml (B en Taub General Hospital, Houston, Texas) and 14.4 +/- 254.3 nmol/ml (Maimo nides, New York, New York). Maternal venous PFCh was 8.4 +/- 3.1 nmol/ml. M aternal venous PPLCh was 2592.1 +/- 584.0 nmol/mL (range = 1227.8-3729.0). Maternal venous PFCh correlated with newborn arterial PFCh (r = 0.53, P < 0 .05) but not with newborn venous PFCh. No correlation was seen between mate rnal venous and newborn PPLCh. No significant differences were seen in PPLC h or choline extraction in Ben Taub versus Maimonides patients, although PF Ch was significantly greater in the newborns from Maimonides (P < 0.05). Th e mean venous PFCh and PPLCh in the preterm infants before beginning TPN wa s 21.2 +/- 6.3 and 1366.8 +/- 339.1 nmol/mL, respectively. Just before init iation of tube feeding (4.0 +/- 2.7 d after TPN had been started), mean ven ous PFCh and PPLCh was 18.4 +/- 5.3 and 2251.8 +/- 686.9 nmol/mL, respectiv ely. When TPN was discontinued and tube feeding increased to goal, after 10 .8 +/- 10.4 d, venous PFCh and PPLCh was 22.6 +/- 8.7 and 2072.5 +/- 540.6 nmol/ml, respectively. Venous PFCh and PPLCh was 13.4 +/- 25 and 1827.5 +/- 327.0 nmol/mL, respectively in the older infant group. Tn conclusion, newb orn PFCh is significantly greater than PFCh in adults but falls to adult le vels within the first year of life. Low maternal PFCh may be associated wit h low newborn PFCh. Normal newborn plasma choline status has no bearing on intrauterine growth, although the rule of maternal choline deficiency in un derweight newborns is unknown. Newborn PPLCh is substantially below that of adults, which suggests its use in membrane synthesis during growth. Nutrit ion 2001;17:18-21. (C)Elsevier Science Inc. 2001.