Colomb V, Dabbas M, Goulet O, Talbotec C, Corriol O, Ricour C
Pediatric Gastroenterology and Nutrition, Necker-Enfants Malades Hospital, Paris, France.
Horm Res. 2002;58 Suppl 1:2-6. doi: 10.1159/000064760.
In children who depend on long-term parenteral nutrition (PN), a major goal is to obtain optimal growth. The aim of this retrospective study was to analyze growth in children on long-term cyclic nocturnal home PN, over at least 8 years before puberty. Nine boys and 7 girls were studied. Their mean age at the time of study was 11 years with a mean PN duration of 10.5 (8.6-16.4) years. Diseases were short bowel syndrome (5), intractable diarrhea (4), chronic intestinal pseudo-obstruction (4) and long segment Hirschsprung's disease (3). In each child, periods of at least 2 years were analyzed: either periods of regular growth (R: height gain >50th percentile), or slow growth (S: height gain < or =25th percentile). Results were expressed as mean +/- SD. Comparisons were performed using either Student's test for unpaired data or Wilcoxon's test for paired data. PN provided a mean of 224 +/- 80 mg nitrogen/kg/day and 43 +/- 14 kcal/kg/day equivalent to 50% of recommended supplies. At the time of study, the population presented with weight (W) = -0.7 +/- 0.8 SD and height (H) = -1.5 +/- 1.3 SD. The difference between W and expected W for H (W/H) was significant (p < 0.002). W/H ratio was 105 +/- 11%. For the total PN duration, weight gain was +0.2 +/- 1.5 SD and height loss was -0.75 +/- 1.4 SD. An excess weight gain occurred in parallel with the deflection of height gain. Of the 16 children, regular prepubertal growth was achieved in 4 only. The other 12 showed alternate periods of R and S. In 8 of them, 26.5 years of R and 33.5 years of S were compared, each child being his own control. PN nitrogen and energy supplies were significantly higher during R periods than during S periods. In the absence of any disease or treatment explaining the failure to thrive, inadequate PN supplies, especially in terms of nitrogen supply, are thought to be responsible for a negative nitrogen balance and slowed growth. In case of any deflection away from the individual growth curve, it is recommended to adjust the PN supply early, especially nitrogen supply.
对于依赖长期肠外营养（PN）的儿童，一个主要目标是实现最佳生长。这项回顾性研究的目的是分析青春期前至少8年接受长期夜间家庭循环PN治疗的儿童的生长情况。研究了9名男孩和7名女孩。研究时他们的平均年龄为11岁，平均PN治疗时间为10.5（8.6 - 16.4）年。疾病包括短肠综合征（5例）、顽固性腹泻（4例）、慢性肠假性梗阻（4例）和长段先天性巨结肠（3例）。对每个儿童至少2年的时间段进行分析：即正常生长阶段（R：身高增长>第50百分位数）或生长缓慢阶段（S：身高增长<或 =第25百分位数）。结果以平均值±标准差表示。使用未配对数据的Student检验或配对数据的Wilcoxon检验进行比较。PN提供的平均氮量为224±80mg/（kg·天），能量为43±14kcal/（kg·天），相当于推荐供应量的50%。研究时，该群体的体重（W）=-0.7±0.8标准差，身高（H）=-1.5±1.3标准差。W与根据H预期的W之间的差异（W/H）具有显著性（p<0.002）。W/H比值为105±11%。在整个PN治疗期间，体重增加为+0.2±1.5标准差，身高降低为-0.75±1.4标准差。体重过度增加与身高增长偏差同时出现。16名儿童中，只有4名在青春期前实现了正常生长。其他12名儿童表现出R和S交替的阶段。其中8名儿童，比较了26.5年的R阶段和33.5年的S阶段，每个儿童以自身作为对照。R阶段的PN氮和能量供应显著高于S阶段。在没有任何疾病或治疗可解释生长发育不良的情况下，PN供应不足，尤其是氮供应不足，被认为是导致负氮平衡和生长缓慢的原因。如果出现偏离个体生长曲线的情况，建议尽早调整PN供应，尤其是氮供应。
