Carnitine deficiency in preterm infants: A national survey of knowledge and practices

M.A. Clark*, R.E.K. Stein, E. J. Silver, S. Khalid, M. Fuloria, N.V. Esteban-Cruciani | JNPM 2018;

OBJECTIVE: Lipid supplementation improves developmental outcomes in preterm infants. Carnitine is essential for lipid metabolism; however, despite high risk for carnitine deficiency, there are no standards for carnitine supplementation in preterm infants receiving total parenteral nutrition (TPN). Our objective was to assess knowledge, beliefs and practices regarding preterm carnitine deficiency and supplementation among neonatal practitioners.
METHODS: Cross-sectional electronic survey administered via a nationally representative listserv of neonatal practitioners.
RESULTS:492 respondents participated in the survey. Only 21% of respondents were aware that carnitine is secreted by the placenta. 72% believed that carnitine deficiency was common, and 60% believed deficiency could have serious consequences. Five percent routinely screened for deficiency, and 40% routinely provided carnitine supplementation. Respondents with >5 years’ experience were more likely to report using carnitine supplementation (50% vs. 38%).
CONCLUSIONS: Although most respondents believed that carnitine deficiency is common and could have serious consequences, few screened for deficiency and fewer than half routinely supplemented. Thus, many preterm infants remain at risk for carnitine deficiency. Further research is needed to elucidate the risks of carnitine deficiency in these vulnerable infants.

*Corresponding Author: 

Marie A. Clark, MD, MPH, Assistant Professor of Pediatrics, UH Rainbow Babies and Children’s Hospital, 10524 Euclid Ave, Ste 3150, Cleveland, OH 44106, USA. Tel.: +1 216 844 3230; Fax: +1 216 201 5188; E-mail: