Porcelli Peter J, Greene Harry, Adcock Eugene
Departments of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina, 27103, USA.
J Pediatr Gastroenterol Nutr. 2004 Apr;38(4):392-400. doi: 10.1097/00005176-200404000-00006.
Very-low-birth-weight (VLBW; birth weight, <1,500 g) infants receive preterm infant formulas and parenteral multivitamin preparations that provide more riboflavin (vitamin B2) than does human milk and more than that recommended by the American Society of Clinical Nutrition. VLBW infants who are not breast-fed may have plasma riboflavin concentrations up to 50 times higher than those in cord blood. The authors examined a vitamin regimen designed to reduce daily riboflavin intake, with the hypothesis that this new regimen would result in lower plasma riboflavin concentrations while maintaining lipid-soluble vitamin levels.
Preterm infants with birth weight < or =1,000 g received either standard preterm infant nutrition providing 0.42 to 0.75 mg riboflavin/kg/day (standard group), or a modified regimen providing 0.19 to 0.35 mg/kg/day (modified group). The modified group parenteral vitamin infusion was premixed in Intralipid. Enteral feedings were selected to meet daily riboflavin administration guidelines. Plasma riboflavin, vitamin A, and vitamin E concentrations were measured weekly by high-performance liquid chromatography. Data were analyzed with the independent t test, chi, and analysis of variance.
The 36 infants (17 standard group, 19 modified group) had birth weight and gestational age of 779 +/- 29 g and 25.5 +/- 0.3 weeks (mean +/- SEM) with no differences between groups. Modified group infants received 38% less riboflavin (0.281 +/- 0.009 mg/kg/day), 35% more vitamin A (318.3 +/- 11.4 microg/kg/day), and 14% more vitamin E (3.17 +/- 0.14 mg/kg/day) than standard group infants. Plasma riboflavin rose from baseline in both groups but was 37% lower in the modified group during the first postnatal month (133.3 +/- 9.9 ng/mL). Riboflavin intake and plasma riboflavin concentrations were directly correlated. Plasma vitamin A (0.222 +/- 0.022 microg/mL) and vitamin E (22.26 +/- 1.61 /mL) concentrations were greater in the modified group.
The modified vitamin regimen resulted in reduced riboflavin intake and plasma riboflavin concentration, suggesting plasma riboflavin concentration is partially dose dependent during the first postnatal month in VLBW infants. Modified group plasma vitamin A and vitamin E concentrations were greater during the first month, possibly because the vitamins were premixed with parenteral lipid emulsion. Because of the complexity of this protocol, the authors suggest that a parenteral multivitamin product designed for VLBW infants which uses weight-based dosing should be developed.
极低出生体重（VLBW；出生体重<1500克）的婴儿接受早产儿配方奶粉和肠外多种维生素制剂，这些制剂提供的核黄素（维生素B2）比母乳多，也超过了美国临床营养学会的推荐量。未进行母乳喂养的极低出生体重婴儿血浆核黄素浓度可能比脐血中的浓度高50倍。作者研究了一种旨在减少每日核黄素摄入量的维生素方案，假设这种新方案将降低血浆核黄素浓度，同时维持脂溶性维生素水平。
出生体重≤1000克的早产儿接受标准的早产儿营养，提供0.42至0.75毫克核黄素/千克/天（标准组），或改良方案，提供0.19至0.35毫克/千克/天（改良组）。改良组的肠外维生素输注在英脱利匹特中预混。选择肠内喂养以满足每日核黄素给药指南。每周通过高效液相色谱法测量血浆核黄素、维生素A和维生素E浓度。数据采用独立t检验、卡方检验和方差分析进行分析。
36名婴儿（17名标准组，19名改良组）的出生体重和胎龄分别为779±29克和25.5±0.3周（平均值±标准误），两组之间无差异。改良组婴儿的核黄素摄入量比标准组婴儿少38%（0.281±0.009毫克/千克/天），维生素A多35%（318.3±11.4微克/千克/天），维生素E多14%（3.17±0.14毫克/千克/天）。两组血浆核黄素均从基线上升，但在出生后的第一个月，改良组的血浆核黄素低37%（133.3±9.9纳克/毫升）。核黄素摄入量与血浆核黄素浓度直接相关。改良组的血浆维生素A（0.222±0.022微克/毫升）和维生素E（22.26±1.61/毫升）浓度更高。
改良后的维生素方案导致核黄素摄入量和血浆核黄素浓度降低，表明在极低出生体重婴儿出生后的第一个月，血浆核黄素浓度部分依赖于剂量。改良组在第一个月的血浆维生素A和维生素E浓度更高，可能是因为这些维生素与肠外脂质乳剂预混。由于该方案的复杂性，作者建议开发一种专为极低出生体重婴儿设计的基于体重给药的肠外多种维生素产品。
