Tapia-Rombo Carlos Antonio, Guerrero-Vara Martha Isabel, Aguilar-Solano Ana Maria Guillermina, Mendoza-Zanella Rosa María, Gómez-de-los-santos Lilia Selenia
Servicio de Neonatología, Unidad Médica de Alta Especialidad, Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, IMSS.
Rev Invest Clin. 2013 Mar-Apr;65(2):116-29.
Associated factors with complications of the parenteral nutrition (PN) in the preterm infant have not been well studied and there are some controversies in the literature.
To identify associated factors with complications of the use of PN in preterm patients Neonatalogy Service.
We performed a longitudinal, observational, retrospective, comparative study (case-control) from January 2008 to December 2010, of the infants who received PN support covering the inclusion criteria (newborns 28 to 36 weeks gestational age from 0 to 28 days after birth, who received PN for at least 6 days). We excluded patients with cholestasis by anatomic obstruction hepatobiliary tract, metabolic disease or congenital metabolic syndrome (inborn errors of metabolism). Statistical analysis was done using descriptive statistics and inferential. The associated factors were investigated through the OR (odds ratio) and multivariate analysis. Significance levels were set at p < 0.05.
The total number of patients studied was 67, which is divided into two groups: group A (n = 35) preterm infants with complications secondary to treatment with PN and group B (n = 32), preterm no complications from the procedure. Of all patients in group A, cases, 13 (37%) had mechanical complications; 14 (40%) patients, infectious related with PN or venous catheter (administration via) and 32 (91.4%) patients with metabolic complications as disorders of glucose homeostasis and hyperglycemia predominated (20 patients in group A which corresponds to 57%). In multivariate analysis revealed as protective factors in the use of average protein < 3 g/kg/ day in the first week, osmolarity of the mixture average < 1,200 mOsm/L and relationship non-nitrogenous calories: protein nitrogen > 140:1.
While there are already installed factors that can not be modified, such as prematurity and low birth weight start nutritional therapy, an adequate proportion of nutrients and osmolality of the mixture can reduce the presence of complications associated with PN.
关于早产儿肠外营养（PN）并发症的相关因素尚未得到充分研究，文献中存在一些争议。
确定新生儿科服务中早产儿使用PN并发症的相关因素。
我们于2008年1月至2010年12月进行了一项纵向、观察性、回顾性、对比研究（病例对照），研究对象为符合纳入标准（出生孕周28至36周、出生后0至28天、接受PN至少6天）的接受PN支持的婴儿。我们排除了因肝胆管解剖性梗阻、代谢疾病或先天性代谢综合征（先天性代谢缺陷）导致胆汁淤积的患者。采用描述性统计和推断性统计进行分析。通过比值比（OR）和多变量分析研究相关因素。显著性水平设定为p < 0.05。
研究的患者总数为67例，分为两组：A组（n = 35）为因PN治疗继发并发症的早产儿，B组（n = 32）为该操作无并发症的早产儿。在A组所有病例中，13例（37%）有机械性并发症；14例（40%）患者有与PN或静脉导管相关的感染（通过静脉导管给药），32例（91.4%）患者有代谢并发症，以葡萄糖稳态紊乱和高血糖为主（A组20例患者，占57%）。多变量分析显示，第一周平均蛋白质使用量< 3 g/kg/天、混合液平均渗透压< 1200 mOsm/L以及非氮热量与蛋白质氮的比值> 140:1为保护因素。
虽然存在一些无法改变的因素，如早产和低出生体重开始营养治疗，但适当的营养成分比例和混合液渗透压可减少与PN相关并发症的发生。
