How important are carnitine and ketones for the newborn infant?

The newborn oxidizes a large amount of fat. This is reflected in the slow rise of plasma levels of ketones and of total carnitines and acylcarnitines. Feeding a diet devoid of carnitine (soy-based formulas, total parenteral nutrition [TPN] ) rapidly results in a fall in plasma total carnitine levels, whereas in the adult such a fall is observed only after a prolonged time of TPN. This suggests that carnitine synthesis in the newborn is less efficient than in the adult. Gluteal adipocytes in the newborn show a rise in carnitine content and in the activity of carnitine transferases soon after birth, when values are higher than in the adult. Their respiration, lipolysis, and triglyceride formation are enhanced by L-carnitine and inhibited by D-carnitine. This is not so in the adult. Addition of L-carnitine to soybean-based formulas decreases plasma triglyceride and free fatty acid levels in premature infants, who have lower carnitine levels at birth than full-term babies. In pregnant women plasma total carnitine levels are significantly depressed. maternal urinary excretion of total carnitine decreases as gestational age increases, and less is also found in amniotic fluid. Plasma levels of total carnitines and acylcarnitine are the same (or higher) in fetal as in maternal plasma. It is concluded that carnitine may be of particular importance to the neonate and that adding it to foods lacking this substance may be advantageous.