Bonsante Francesco, Iacobelli Silvia, Latorre Giuseppe, Rigo Jacques, De Felice Claudio, Robillard Pierre Yves, Gouyon Jean Bernard
Néonatologie et Réanimation Pédiatrique et Néonatale, Centre Hospitalier Universitaire de la Réunion, France.
PLoS One. 2013 Aug 15;8(8):e72880. doi: 10.1371/journal.pone.0072880. eCollection 2013.
Early aggressive parenteral nutrition (PN), consisting of caloric and nitrogen intake soon after birth, is currently proposed for the premature baby. Some electrolyte disturbances, such as hypophosphatemia and hypercalcemia, considered unusual in early life, were recently described while using this PN approach. We hypothesize that, due to its impact on cell metabolism, the initial amino acid (AA) amount may specifically influence the metabolism of phosphorus, and consequently of calcium. We aim to evaluate the influence of AA intake on calcium-phosphorus metabolism, and to create a calculation tool to estimate phosphorus needs.
Prospective observational study. Phosphate and calcium plasma concentrations and calcium balance were evaluated daily during the first week of life in very preterm infants, and their relationship with nutrition was studied. For this purpose, infants were divided into three groups: high, medium and low AA intake (HAA, MAA, LAA). A calculation formula to assess phosphorus needs was elaborated, with a theoretical model based on AA and calcium intake, and the cumulative deficit of phosphate intake was estimated.
154 infants were included. Hypophosphatemia (12.5%) and hypercalcemia (9.8%) were more frequent in the HAA than in the MAA (4.6% and 4.8%) and in the LAA group (0% and 1.9%); both p<0.001.
Calcium-phosphorus homeostasis was influenced by the early AA intake. We propose to consider phosphorus and calcium imbalances as being part of a syndrome, related to incomplete provision of nutrients after the abrupt discontinuation of the placental nutrition at birth (PI-ReFeeding syndrome). We provide a simple tool to calculate the optimal phosphate intake. The early introduction of AA in the PN soon after birth might be completed by an early intake of phosphorus, since AA and phosphorus are (along with potassium) the main determinants of cellular growth.
目前建议对早产儿采用早期积极的肠外营养（PN），即在出生后不久就给予热量和氮摄入。在使用这种PN方法时，最近发现了一些在生命早期被认为不常见的电解质紊乱，如低磷血症和高钙血症。我们假设，由于其对细胞代谢的影响，初始氨基酸（AA）量可能会特别影响磷的代谢，进而影响钙的代谢。我们旨在评估AA摄入对钙磷代谢的影响，并创建一个计算工具来估计磷的需求量。
前瞻性观察研究。对极早产儿出生后第一周每天评估血浆磷酸盐和钙浓度以及钙平衡，并研究它们与营养的关系。为此，将婴儿分为三组：高、中、低AA摄入量组（HAA、MAA、LAA）。根据AA和钙摄入量，利用理论模型制定了评估磷需求量的计算公式，并估计了磷摄入的累积不足量。
纳入154名婴儿。HAA组低磷血症（12.5%）和高钙血症（9.8%）的发生率高于MAA组（4.6%和4.8%）和LAA组（0%和1.9%）；两者p<0.001。
早期AA摄入影响钙磷稳态。我们建议将钙磷失衡视为一种综合征的一部分，该综合征与出生时胎盘营养突然中断后营养供应不完全有关（胎盘-再喂养综合征）。我们提供了一个简单的工具来计算最佳磷摄入量。由于AA和磷（与钾一起）是细胞生长的主要决定因素，出生后不久在PN中尽早引入AA可能需要尽早摄入磷来完善。
