Miller Malki, Vaidya Ruben, Rastogi Deepa, Bhutada Alok, Rastogi Shantanu
Department of Nutrition, Maimonides Infants and Children's Hospital, Brooklyn, New York.
JPEN J Parenter Enteral Nutr. 2014 May;38(4):489-97. doi: 10.1177/0148607113487926. Epub 2013 May 14.
Nutrition practices for preterm infants include phases of parenteral nutrition (PN), full enteral nutrition (EN), and the transitional phase in between. Our aim was to identify the nutrition phases during which infants are most likely to exhibit poor growth that would affect risk for growth failure (GF) at discharge and to examine factors associated with GF.
A retrospective chart review was conducted on infants born <32 weeks' gestation. The neonatal intensive care unit stay was divided into 3 nutrition phases: (1) full PN, (2) transitional PN + EN, and (3) full EN. Weekly growth rates were calculated, and for each growth velocity <10 g/kg/d, the coinciding phase was recorded. GF was defined as a discharge weight below the 10th percentile. The nutrition phases during which growth inadequacy predicted GF at discharge were determined, correcting for other clinical factors associated with GF.
In total, 156 eligible infants were identified. Seventy-six infants (49%) were discharged with weights <10%. Incidence of poor growth was highest during the transitional phase (46%) and was predictive of GF when adjusted for gestational age, birth weight, and severity of illness. Although energy intakes during the transitional phase were comparable to baseline parenteral provision, protein intakes progressively decreased ( P < .0001), consistently providing 3 g/kg/d as PN was weaned. Serum urea nitrogen also declined and was correlated with protein intake (r = -0.32, P < .001).
Growth was compromised during the transitional phase, likely related to decreased protein intake. Optimizing protein provision while PN is weaned is an important strategy to prevent postnatal growth failure.
早产儿的营养支持包括肠外营养（PN）阶段、完全肠内营养（EN）阶段以及两者之间的过渡阶段。我们的目的是确定婴儿最有可能出现生长不良的营养阶段，这种生长不良会影响出院时生长发育迟缓（GF）的风险，并研究与GF相关的因素。
对孕周小于32周的婴儿进行回顾性病历审查。新生儿重症监护病房住院期分为3个营养阶段：（1）完全PN，（2）过渡性PN + EN，（3）完全EN。计算每周生长速率，对于每个生长速度<10 g/kg/d的情况，记录相应阶段。GF定义为出院体重低于第10百分位数。确定生长不足预测出院时GF的营养阶段，并校正与GF相关的其他临床因素。
共确定156例符合条件的婴儿。76例婴儿（49%）出院时体重<第10百分位数。生长不良发生率在过渡阶段最高（46%），在调整胎龄、出生体重和疾病严重程度后可预测GF。虽然过渡阶段的能量摄入量与肠外营养的基线供给量相当，但蛋白质摄入量逐渐下降（P <.0001），随着PN的撤减，蛋白质摄入量持续维持在3 g/kg/d。血清尿素氮也下降，且与蛋白质摄入量相关（r = -0.32，P <.001）。
过渡阶段生长受到影响，可能与蛋白质摄入量减少有关。在撤减PN时优化蛋白质供给是预防出生后生长发育迟缓的重要策略。
