Carnitine performs a crucial role in the energy supply of tissues during fetal life and in the neonatal period by controlling the influx of fatty acids into mitochondria. Carnitine also facilitates the oxidation of pyruvate and branched chain amino acids, and contributes to the protection of cells from the deleterious actions of acyl CoAs. Carnitine further acts as a secondary antioxidant, favouring fatty acid replacement within previously oxidatively damaged membrane phospholipids. Availability of L-carnitine is essential in the developing fetus for processes underlying fetal maturation. L-carnitine is also essential for development of hepatic ketone synthesis, a central pathway for neonatal energy metabolism. Ketone bodies inhibit the oxidation of both glucose and lactate, sparing these metabolic substrates for biosynthetic functions.