Dalgiç Nazan, Hasanoğlu Alev, Tümer Leyla, Koç Esin, Ergenekon Ebru, Cinasal Gülden, Bukan Neslihan
Department of Paediatrics, Division of Metabolism and Nutrition, Gazi University, Faculty of Medicine, Ankara, Turkey.
Ann Nutr Metab. 2007;51(1):22-6. doi: 10.1159/000100817. Epub 2007 Mar 14.
Free radical production is increased by the administration of total parenteral nutrition (TPN) and may be linked to its adverse effects. Some of the complications of TPN can be ameliorated by partial enteral feeding. In the present study, we investigated plasma nitrate/nitrite (NO(2)/NO(3)) levels in newborns under parenteral and enteral plus parenteral nutrition (PN).
Six categories of patients were studied: (1) 10 term infants receiving enteral feeding, (2) 10 term infants receiving PN plus enteral feeding, (3) 10 term infants receiving TPN, (4) 10 preterm infants receiving enteral feeding, (5) 10 preterm infants receiving PN plus enteral feeding, and (6) 10 preterm infants receiving TPN. Plasma nitrate/nitrite levels were measured in all infants initially and in infants receiving TPN and PN plus enteral feeding on the 1st and 5th days, 3 h after the lipid infusion.
There was a statistically significant difference in the weighs of infants between the term and preterm groups. There was no difference in NO(2)/NO(3) levels between the term and preterm groups. When the groups of term (groups 1, 2, 3) and preterm (groups 4, 5, 6) infants were compared separately within the groups, no statistically significant difference was found in any parameters. We also made comparison among the six groups' gestational ages, and we found a difference between all term groups and all preterm groups except between groups 1 and 2; groups 1 and 3; groups 2 and 3; groups 4 and 5, and groups 5 and 6 (p < 0.05). Furthermore, the baseline, 1st and 5th days NO(2)/NO(3) levels were compared in the term and preterm groups receiving PN. Plasma NO(2)/NO(3)levels before TPN were significantly lower in the term infants receiving parenteral fluids compared with NO(2)/NO(3) levels of 1st day of TPN (p < 0.05). In preterm infants receiving TPN the NO(2)/NO(3) levels before TPN were significantly lower than the levels on the 5th day of PN (p < 0.05). There was no significant difference among other NO(2)/NO(3) levels of the patients at baseline, 1st and 5th days in the term and preterm groups. Partial enteral feeding did not change the levels of NO(2)/NO(3) in term and preterm infants on PN.
This study shows that TPN has some impact on nitric oxide (NO) production in newborn and partial enteral nutrition does not reduce this effect. However, since the numbers are very small these findings need to be verified by larger groups of patients.
全胃肠外营养（TPN）会增加自由基生成，这可能与其不良反应有关。部分肠内营养可改善TPN的一些并发症。在本研究中，我们调查了接受肠外营养和肠内加肠外营养（PN）的新生儿血浆硝酸盐/亚硝酸盐（NO₂/NO₃）水平。
研究了六类患者：（1）10名足月儿接受肠内喂养；（2）10名足月儿接受PN加肠内喂养；（3）10名足月儿接受TPN；（4）10名早产儿接受肠内喂养；（5）10名早产儿接受PN加肠内喂养；（6）10名早产儿接受TPN。在所有婴儿最初以及接受TPN和PN加肠内喂养的婴儿于第1天和第5天脂质输注后3小时测量血浆硝酸盐/亚硝酸盐水平。
足月儿组和早产儿组婴儿体重存在统计学显著差异。足月儿组和早产儿组的NO₂/NO₃水平无差异。当分别比较足月儿组（第1、2、3组）和早产儿组（第4、5、6组）内的组间情况时，任何参数均未发现统计学显著差异。我们还比较了六组的胎龄，发现除第1组和第2组、第1组和第3组、第2组和第3组、第4组和第5组以及第5组和第6组外，所有足月儿组和所有早产儿组之间存在差异（p<0.05）。此外，比较了接受PN的足月儿组和早产儿组的基线、第1天和第5天的NO₂/NO₃水平。接受肠外补液的足月儿在TPN前的血浆NO₂/NO₃水平显著低于TPN第1天的水平（p<0.05）。接受TPN的早产儿在TPN前的NO₂/NO₃水平显著低于PN第5天的水平（p<0.05）。足月儿组和早产儿组患者在基线、第1天和第5天的其他NO₂/NO₃水平之间无显著差异。部分肠内喂养未改变接受PN的足月儿和早产儿的NO₂/NO₃水平。
本研究表明TPN对新生儿一氧化氮（NO）生成有一定影响，部分肠内营养并不能降低这种影响。然而，由于样本量非常小，这些发现需要更大规模的患者群体进行验证。
