Embleton Nicholas D, Simmer Karen
Newcastle Neonatal Service, Newcastle Hospitals NHS Foundation Trust, Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
World Rev Nutr Diet. 2014;110:177-89. doi: 10.1159/000358466. Epub 2014 Apr 11.
Preterm infants have limited nutrient stores at birth, take time to establish enteral feeding, are at risk of accumulating significant nutrient deficits, and frequently suffer poor growth - all risks which are associated with poorer neurodevelopmental outcome. Parenteral nutrition (PN) provides a relatively safe means of meeting nutrient intakes, and is widely used in preterm infants in the initial period after birth. PN is also important for infants who may not tolerate enteral feeds such as those with congenital or acquired gut disorders such as necrotizing enterocolitis (NEC). PN is associated with several short-term benefits, but clear evidence of long-term benefit from controlled trials in neonates is lacking. There are many compositional, practical and risk aspects involved in neonatal PN. In most preterm infants, authorities recommend amino acid intakes approximating to 3.5-4 g/kg/day of protein, lipid intakes of 3-4 g/kg/day and sufficient carbohydrate to meet a total energy intake of 90-110 kcal/kg/day. Where PN is the sole source of nutrition, careful attention to micronutrient requirements is necessary. PN may be administered via peripheral venous access if the osmolality allows, but in many cases requires central venous access. Standardized PN bags may meet the nutrient needs of many preterm infants over the first few days, although restricted fluid intakes mean that many receive inadequate amounts especially of amino acids. PN can be associated with increased rates of bacterial and fungal sepsis, mechanical complications related to venous line placement and miscalculations and errors in manufacture, supply and administration. PN is also associated with metabolic derangements, hepatic dysfunction, and risks contamination with toxins such as aluminum, which enter the solutions during manufacturing. PN must only be administered in units with good quality control, strict asepsis in manufacture and administration and multidisciplinary teams focused on nutrient needs and intakes.
早产儿出生时营养储备有限，需要时间来建立肠内喂养，有累积显著营养缺乏的风险，且经常生长发育不良——所有这些风险都与较差的神经发育结局相关。肠外营养（PN）提供了一种相对安全的满足营养摄入的方式，在早产儿出生后的初始阶段被广泛使用。PN对于那些可能无法耐受肠内喂养的婴儿也很重要，比如患有先天性或后天性肠道疾病（如坏死性小肠结肠炎（NEC））的婴儿。PN有几个短期益处，但缺乏来自新生儿对照试验的长期益处的确切证据。新生儿PN涉及许多成分、实际操作和风险方面。在大多数早产儿中，权威机构建议蛋白质的氨基酸摄入量约为3.5 - 4克/千克/天，脂肪摄入量为3 - 4克/千克/天，并摄入足够的碳水化合物以满足90 - 110千卡/千克/天的总能量摄入。当PN是唯一的营养来源时，需要仔细关注微量营养素需求。如果渗透压允许，PN可以通过外周静脉通路给药，但在许多情况下需要中心静脉通路。标准化的PN袋在最初几天可能满足许多早产儿的营养需求，尽管液体摄入量受限意味着许多婴儿尤其是氨基酸摄入量不足。PN可能与细菌和真菌败血症的发生率增加、与静脉置管相关的机械并发症以及制造、供应和给药过程中的计算错误和失误有关。PN还与代谢紊乱、肝功能障碍以及诸如铝等毒素污染的风险有关，铝在制造过程中会进入溶液。PN必须仅在具备良好质量控制、制造和给药过程严格无菌以及专注于营养需求和摄入量的多学科团队的单位中使用。
