Sirch Melanie, Poryo Martin, Butte Mona, Lindner Ulrike, Gortner Ludwig, Zemlin Michael, Nunold Holger, Meyer Sascha
Klinik für Allgemeine Pädiatrie und Neonatologie, Universitätsklinikum des Saarlandes, Geb. 9, Kirrberger Str., 66421, Homburg, Deutschland.
Klinik für Pädiatrische Kardiologie, Universitätsklinikum des Saarlandes, 66421, Homburg, Deutschland.
Wien Med Wochenschr. 2019 Mar;169(3-4):71-81. doi: 10.1007/s10354-017-0602-2. Epub 2017 Oct 13.
Parenteral and enteral nutrition are essential for both growth and development of preterm infants. Based on the results of many studies, the rate of nutritional growth and the amount of substrate delivered parenterally are under debate.
The main aim of this study was to assess parenteral nutrition in very and extremely immature preterm infants, i.e. very low birth weight (VLBW, birth weight <1500g) and extremely low birth weight (ELBW, birth weight <1000g) neonates, and to compare the amount of parenterally delivered substrate in our neonatal intensive care unit (NICU) to current German guidelines.
Retrospective audit at our tertiary NICU at the University Children's Hospital of Saarland, Homburg, Germany between 1 January 2009 and 31 December 2010.
In total, 100 premature neonates were included. The mean gestational age was 29.6 weeks (range 24.4-34.1 weeks) and the mean birth weight was 1119 g ± 260 g (range 570 g-1490 g). Comparing the amount of fluids, glucose, amino acids, lipids and kcals with the current guidelines of the German Society for Nutritional Medicine in preterm infants, only glucose was adequately given; however, a substantial number of weight-dependent (more often in ELBW neonates) episodes of hyperglycemia requiring insulin treatment were also seen. During the first 3 weeks of life a substantial drop in body weight, length and head circumference occurred in our study cohort. In contrast, at 2 years corrected age, catch-up growth was seen in our cohort with anthropometric data now comparable to healthy term infants. Using the Bayley II test for developmental outcome assessment, at 2 years corrected age 78.6% (33/42) of infants demonstrated normal development.
This retrospective data analysis demonstrated inadequate provision of parenteral nutrition in our NICU, which was often not in line with current German guidelines. This was associated with inadequate growth in our cohort, most notably during the first 3 weeks of life; however, implementation of current guidelines is impeded by metabolic disturbances in this cohort, most notably in ELBW neonates. Whether adherence to published guidelines will result in better early ex utero growth, and whether this normalized growth pattern will translate into better long-term outcome on a metabolic and neurological level, remains unclear.
肠外营养和肠内营养对早产儿的生长发育至关重要。基于多项研究结果，营养生长速率和肠外营养底物供给量仍存在争议。
本研究的主要目的是评估极不成熟和非常不成熟的早产儿，即极低出生体重（VLBW，出生体重<1500g）和超低出生体重（ELBW，出生体重<1000g）新生儿的肠外营养情况，并将我们新生儿重症监护病房（NICU）的肠外营养底物供给量与德国现行指南进行比较。
对德国洪堡萨尔兰大学儿童医院三级NICU在2009年1月1日至2010年12月31日期间进行回顾性审计。
共纳入100例早产儿。平均胎龄为29.6周（范围24.4 - 34.1周），平均出生体重为1119 g±260 g（范围570 g - 1490 g）。将液体、葡萄糖、氨基酸、脂质和千卡的供给量与德国营养医学学会关于早产儿的现行指南进行比较，仅葡萄糖供给充足；然而，也观察到大量依赖体重的（在ELBW新生儿中更常见）高血糖发作需要胰岛素治疗。在生命的前3周，我们的研究队列中体重、身长和头围出现了显著下降。相比之下，在矫正年龄2岁时，我们的队列中出现了追赶生长，人体测量数据现在与健康足月儿相当。使用贝利婴幼儿发展量表第二版进行发育结局评估，在矫正年龄2岁时，78.6%（33/42）的婴儿发育正常。
这项回顾性数据分析表明，我们的NICU中肠外营养供给不足，这通常不符合德国现行指南。这与我们队列中的生长不足有关，最明显的是在生命的前3周；然而，该队列中的代谢紊乱，最明显的是在ELBW新生儿中，阻碍了现行指南的实施。遵循已发表的指南是否会导致更好的宫外早期生长，以及这种正常化的生长模式是否会在代谢和神经水平上转化为更好的长期结局，仍不清楚。
