Vakrilova L, Sluncheva B, Emilova Z, Pramatarova T, Jarukova N, Radulova P, Chitrova S, Petrova G
Akush Ginekol (Sofiia). 2010;49(2):3-13.
Newborn infants with birth weight 1500 g and less (VLBW/ELBW) have higher nutritional needs, but enteral feeding is often insufficient or impossible. Parenteral nutrition (PN) as an important component of intensive care with them minimizes the risk of nutritional deficiency.
To evaluate the safety and efficacy of early PN administration in VLBW/ELBW infants.
The prospective study includes 23 newborn babies with birthweight below 1500 g who were admitted to the NICU from 01.03. to 20.04. 2009. With all babies a PN was started from the first day of life with dextrose and amino acid solutions, adding lipid solutions in gradually increasing quantity on the second day. During the first 20 days of life for each baby were calculated on a daily basis the exact quantities of energy and the essential nutritional substances as well as the balance among them. All babies were followed up for weight gain, presence or absence of complications, related with parenteral nutrition as well as for: blood sugar, acid-base status, total serum protein, electrolytes, urea, triglycerides, billirubin, alkaline phosphatase, ASAT ALAT RESULTS: We found that due to the small infusion volumes during the first days, the minimal daily needed nutrition levels are reached at day 4-5. Nutritional intake at day 7-10 in most children is enough for growth. A positive mean weight gain for the whole group 6.6 g/kg/d (SD 6.2) is observed. Negative weight gain during the first 20 days is observed only with two critically ill babies with substantial reduction of infusion volume. In 9 babies a transient increase in urea levels was observed during the first week, 5 babies had an increase in triglycerides as a symptom of bad lipid tolerance. In 7 babies on prolonged total PN an increase in alkaline phosphatase is observed. Conclusions. Early and sufficient PN in newborn babies below 1500 g guarantees the daily intake of energy and essential nutritive substances for adequate growth and is a basic component of intensive therapy. It should be corresponding to the nutritional needs as well as to the clinical condition; matching the severity of complications and carried under strict laboratory control.
出生体重1500克及以下的新生儿（极低出生体重儿/超低出生体重儿）营养需求更高，但肠内喂养往往不足或无法进行。肠外营养（PN）作为对他们进行重症监护的重要组成部分，可将营养缺乏风险降至最低。
评估早期给予极低出生体重儿/超低出生体重儿肠外营养的安全性和有效性。
这项前瞻性研究纳入了23名出生体重低于1500克的新生儿，他们于2009年3月1日至4月20日入住新生儿重症监护病房（NICU）。所有婴儿从出生第一天开始接受肠外营养，给予葡萄糖和氨基酸溶液，第二天开始逐渐增加脂肪溶液的量。在出生后的前20天，每天计算每个婴儿的确切能量和必需营养物质的量以及它们之间的平衡。对所有婴儿进行随访，观察体重增加情况、是否存在与肠外营养相关的并发症，以及血糖、酸碱状态、总血清蛋白、电解质、尿素、甘油三酯、胆红素、碱性磷酸酶、谷草转氨酶、谷丙转氨酶的情况。结果：我们发现，由于最初几天输液量较小，在第4 - 5天达到每日所需的最低营养水平。大多数儿童在第7 - 10天的营养摄入量足以支持生长。观察到整个组的平均体重增加为6.6克/千克/天（标准差6.2）。仅在两名病情严重、输液量大幅减少的婴儿中观察到出生后前20天体重下降。9名婴儿在第一周出现尿素水平短暂升高，5名婴儿甘油三酯升高，提示脂肪耐受性差。7名长期接受全肠外营养的婴儿碱性磷酸酶升高。结论：对体重低于1500克的新生儿早期给予充足的肠外营养可保证每日摄入足够的能量和必需营养物质以实现充分生长，是强化治疗的基本组成部分。它应与营养需求以及临床状况相适应；与并发症的严重程度相匹配，并在严格的实验室监测下进行。
