Bellagamba Maria Paola, Carmenati Elisabetta, D'Ascenzo Rita, Malatesta Michela, Spagnoli Cristina, Biagetti Chiara, Burattini Ilaria, Carnielli Virgilio P
*Division of Neonatology, Department of Mother and Child Health, Ospedale Salesi-Azienda Ospedaliero Universitaria Ospedali Riuniti †Department of Medical Sciences, Polytechnic University of Marche, Ancona, Italy.
J Pediatr Gastroenterol Nutr. 2016 Jun;62(6):879-84. doi: 10.1097/MPG.0000000000000989.
The aim of the study was to evaluate the effect on growth and neurodevelopment of increasing amino acid (AA) during parenteral nutrition and protein intake during enteral nutrition in extremely low birth-weight infants starting from birth to day of reaching 1800 g body weight.
We randomized preterm infants with birth weight 500 to 1249 g either to a high AA/protein intake (HiP [high protein]: parenteral nutrition = 3.5 AA, enteral nutrition = 4.6 protein g · kg · day) or to a standard of care group (StP [standard protein]: parenteral nutrition = 2.5 AA, enteral nutrition = 3.6 protein g · kg · day). The primary outcome was weight gain from birth to 1800 g.
TWO:: hundred twenty-six patients were screened, 164 completed the study and were analyzed (82 StP and 82 HiP). Cumulative AA/protein intake from birth to 1800 g was 178 ± 42 versus 223 ± 45 g/kg in the StP versus HiP group respectively, P < 0.0001.Blood urea was higher in HiP than in StP group both during parenteral and enteral nutrition (P = 0.004).Weight gain from birth to 1800 g was 12.3 ± 1.6 in StP and 12.6 ± 1.7 g · kg · day in HiP group (P = 0.294). We found no difference in any growth parameters neither during hospital stay nor at 2 years corrected age. Bayley III score at 24 months corrected age was 93.8 ± 12.9 in StP group and 94.0 ± 13.9 in the HiP group, P = 0.92.
Increasing AA/protein intake both during parenteral and enteral nutrition does not improve growth and neurodevelopment of small preterm infants 500 to 1249 g birth weight.
本研究旨在评估从出生到体重达到1800克期间，肠外营养期间增加氨基酸（AA）以及肠内营养期间增加蛋白质摄入量对极低出生体重儿生长和神经发育的影响。
我们将出生体重为500至1249克的早产儿随机分为高AA/蛋白质摄入量组（HiP[高蛋白]：肠外营养=3.5 AA，肠内营养=4.6克蛋白质·千克·天）或标准治疗组（StP[标准蛋白质]：肠外营养=2.5 AA，肠内营养=3.6克蛋白质·千克·天）。主要结局是从出生到1800克的体重增加。
共筛查了226例患者，164例完成研究并进行分析（82例StP组和82例HiP组）。StP组和HiP组从出生到1800克的累积AA/蛋白质摄入量分别为178±42和223±45克/千克，P<0.0001。在肠外和肠内营养期间，HiP组的血尿素均高于StP组（P=0.004）。StP组从出生到1800克的体重增加为12.3±1.6，HiP组为12.6±1.7克·千克·天（P=0.294）。我们发现在住院期间和2岁矫正年龄时，任何生长参数均无差异。矫正年龄24个月时的贝利III评分，StP组为93.8±12.9，HiP组为94.0±13.9，P=0.92。
在肠外和肠内营养期间增加AA/蛋白质摄入量并不能改善出生体重为500至1249克的小早产儿的生长和神经发育。
