Grover Anuj, Khashu Minesh, Mukherjee Anindyalal, Kairamkonda Venkatesh
Neonatal Unit, Leicester Royal Infirmary, Leicester, UK.
JPEN J Parenter Enteral Nutr. 2008 Mar-Apr;32(2):140-4. doi: 10.1177/0148607108314373.
Extrauterine growth retardation is a major clinical problem in very-low-birth-weight infants. Parenteral nutrition (PN) serves to achieve rapid maximal nutrition in early postnatal life. There is a lack of uniformity with regard to neonatal PN practice. The objective of this study is to ascertain current practice regarding neonatal PN prescription in the early postnatal period in the United Kingdom.
A study questionnaire was e-mailed to neonatal pharmacists serving level 3 and major level 2 units in the United Kingdom between October 2005 and March 2006. Static numerical information regarding glucose, amino acids, and lipid prescription during the first 10 days of life was collected and compared with current recommendations.
Fifty-two (81%) units responded to the questionnaire; 4 units were excluded for incomplete data. Twenty-six units (54%) initiated PN on day 1. Full PN was achieved by the median age of 6 days. Twelve units (25%) achieved full PN only by day 7 or later. Maximum median amino acids were 2.9 g/kg/d. Only 13 units (27%) prescribed >/=3 g/kg/d, and 2 prescribed more than 3.5 g/kg/d. Nineteen units (39%) initiated lipids on day 1. Eleven units (23%) delayed lipids until day 3, and 2 units delayed lipids until day 4. In comparison to the recommended intake of calories and amino acids, the current median prescription would result in a cumulative deficit over the first 10 days of 420 kcal/kg and 11.9 g/kg, respectively.
Our study suggests diverse practice with regard to neonatal PN prescription in the United Kingdom. Current neonatal PN practice entails a significant calorie and protein deficit during early postnatal life and warrants further review.
宫外生长迟缓是极低出生体重儿的一个主要临床问题。肠外营养（PN）有助于在出生后早期实现快速最大程度的营养供给。新生儿PN的应用缺乏一致性。本研究的目的是确定英国出生后早期新生儿PN处方的当前应用情况。
2005年10月至2006年3月期间，通过电子邮件向英国三级及主要二级医疗单位的新生儿药剂师发送研究问卷。收集出生后前10天内葡萄糖、氨基酸和脂质处方的静态数值信息，并与当前建议进行比较。
52个（81%）单位回复了问卷；4个单位因数据不完整被排除。26个单位（54%）在出生第1天开始PN。到第6天中位数年龄时实现了全肠外营养。12个单位（25%）直到第7天或更晚才实现全肠外营养。最大中位数氨基酸量为2.9 g/kg/d。只有13个单位（27%）处方量≥3 g/kg/d，2个单位处方量超过3.5 g/kg/d。19个单位（39%）在出生第1天开始使用脂质。11个单位（23%）将脂质使用推迟到第3天，2个单位推迟到第4天。与推荐的热量和氨基酸摄入量相比，当前的中位数处方在出生后的前10天分别会导致420 kcal/kg和11.9 g/kg的累积不足。
我们的研究表明英国在新生儿PN处方方面存在多种不同做法。当前新生儿PN的应用在出生后早期会导致显著的热量和蛋白质不足，值得进一步审查。
