Department of Pediatric Gastroenterology, Hepatology and Nutrition, National Reference Center for Rare Digestive Diseases in Children, APHP, Necker Enfants Malades University Hospital, Paris, France.
University of Sorbonne-Paris-Cité, Paris Descartes, Paris, France.
JPEN J Parenter Enteral Nutr. 2018 Jan;42(1):78-86. doi: 10.1002/jpen.1014. Epub 2017 Dec 15.
Infants with intestinal failure (IF) are at increased risk of malnutrition and require adapted nutrition support. Optimal weight gain during nutrition rehabilitation should occur at the velocity of statural age (adjusted to the 50 percentile of height) and not chronological age. The aim of this study was to assess the relationship between weight gain during catch-up growth, nonprotein energy intake (NPEI) provided by total parenteral nutrition (TPN), and resting energy expenditure (REE) in children with severe malnutrition due to IF.
This retrospective study included all infants with severe malnutrition treated with TPN for IF between January 1, 2010, and December 31, 2013. They all had no or minimal oral intake (<10% REE). The REE was calculated using the Schofield equations.
Seventeen children were included (11 boys) with a mean age at TPN onset of 5 mo. They were followed for a mean duration of 39 days. On admission, body weight and height were -3.1 ± 0.9 and -3.3 ± 1.3 SD, respectively. The indications for TPN were short bowel syndrome (n = 10), congenital enteropathy (microvillous inclusion disease, n = 6) and chronic intestinal pseudo-obstruction syndrome (n = 1). After 28 days of nutrition rehabilitation with full NPEI from TPN, the observed weight gain was 110 ± 5% of optimal weight gain for statural age. The mean NPEI from TPN was 104.3 ± 8.0 kcal/kg/d. The mean ratio of NPEI over REE was 2.1 ± 0.2.
Optimal weight gain was achieved with NPEI from TPN twice the REE in severely malnourished infants with IF. NPEI values were adequate and not excessive for age.
患有肠衰竭（IF）的婴儿有发生营养不良的风险增加，需要进行适当的营养支持。营养康复过程中的最佳体重增加速度应该与身高的实际年龄（调整到身高的第 50 个百分位数）相匹配，而不是与实际年龄相匹配。本研究的目的是评估在 IF 导致严重营养不良的儿童中，追赶生长期间的体重增加、全肠外营养（TPN）提供的非蛋白能量摄入（NPEI）与静息能量消耗（REE）之间的关系。
这项回顾性研究纳入了 2010 年 1 月 1 日至 2013 年 12 月 31 日期间因 IF 接受 TPN 治疗的所有严重营养不良的婴儿。所有患儿都没有或仅有少量口服摄入（<10%REE）。REE 是使用 Schofield 公式计算的。
共纳入 17 名儿童（11 名男孩），TPN 起始时的平均年龄为 5 个月。他们的平均随访时间为 39 天。入院时，体重和身高分别为-3.1 ± 0.9 和-3.3 ± 1.3 SD。TPN 的适应证为短肠综合征（n = 10）、先天性肠病（微绒毛包涵体病，n = 6）和慢性肠假性梗阻综合征（n = 1）。经过 28 天的 TPN 全 NPEI 营养康复后，观察到的体重增加为按身高实际年龄计算的最佳体重增加的 110 ± 5%。TPN 的平均 NPEI 为 104.3 ± 8.0 kcal/kg/d。NPEI 与 REE 的平均比值为 2.1 ± 0.2。
在 IF 导致严重营养不良的婴儿中，TPN 提供的 NPEI 是 REE 的两倍时，可以实现最佳体重增加。按年龄计算，NPEI 值是充足的，而不是过量的。
