Binder Christoph, Longford Nicholas, Gale Chris, Modi Neena, Uthaya Sabita
Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care Medicine and Neuropediatrics, Medical University Vienna, Vienna, Austria.
Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Campus, London, United Kingdom.
Neonatology. 2018;113(3):242-248. doi: 10.1159/000485827. Epub 2018 Jan 23.
The optimal nutritional regimen for preterm infants, including those that develop necrotising enterocolitis (NEC), is unknown.
The objective here was to evaluate body composition at term in infants following NEC, in comparison with healthy infants. The primary outcome measure was non-adipose tissue mass (non-ATM).
We compared body composition assessed by magnetic resonance imaging at term in infants born <31 weeks of gestational age that participated in NEON, a trial comparing incremental versus immediate delivery of parenteral amino acids on non-ATM, and SMOF versus intralipid on intrahepatocellular lipid content. There were no differences in the primary outcomes. We compared infants that received surgery for NEC (NEC-surgical), infants with medically managed NEC (NEC-medical), and infants without NEC (reference).
A total of 133 infants were included (8 NEC-surgical; 15 NEC-medical; 110 reference). In comparison with the reference group, infants in the NEC-surgical and NEC-medical groups were significantly lighter [adjusted mean difference (95% CI) NEC-surgical: -630 g (-1,010, -210), p = 0.003; NEC-medical: -440 g (-760, -110), p = 0.009] and the total adipose tissue volume (ATV) was significantly lower [NEC-surgical: -360 cm3 (-516, -204), p < 0.001; NEC-medical: -127 cm3 (-251, -4); p = 0.043]. There were no significant differences in non-ATM [adjusted mean difference (95% CI) NEC-surgical: -46 g (-281, 189), p = 0.70; NEC-medical: -122 g (-308, 63), p = 0.20].
The lower weight at term in preterm infants following surgically and medically managed NEC, in comparison to preterm infants that did not develop the disease, was secondary to a reduction in ATV. This suggests that the nutritional regimen received was adequate to preserve non-ATM but not to support the normal third-trimester deposition of adipose tissue in preterm infants.
早产婴儿（包括发生坏死性小肠结肠炎（NEC）的婴儿）的最佳营养方案尚不清楚。
本研究旨在评估NEC患儿足月时的身体组成，并与健康婴儿进行比较。主要结局指标为非脂肪组织质量（non-ATM）。
我们比较了参与NEON试验的孕龄<31周的足月婴儿的身体组成，该试验比较了肠外氨基酸递增给药与立即给药对non-ATM的影响，以及结构中/长链脂肪乳剂（SMOF）与中链甘油三酯/长链甘油三酯（intralipid）对肝细胞内脂质含量的影响。主要结局指标无差异。我们比较了接受NEC手术治疗的婴儿（NEC-手术组）、接受NEC药物治疗的婴儿（NEC-药物组）和未患NEC的婴儿（参照组）。
共纳入133例婴儿（8例NEC-手术组；15例NEC-药物组；110例参照组）。与参照组相比，NEC-手术组和NEC-药物组的婴儿体重明显更轻[校正平均差（95%CI），NEC-手术组：-630 g（-1,010，-210），p = 0.003；NEC-药物组：-440 g（-7,60，-110），p = 0.009]，总脂肪组织体积（ATV）明显更低[NEC-手术组：-360 cm³（-516，-204），p < 0.001；NEC-药物组：-127 cm³（-251，-4）；p = 0.043]。non-ATM无显著差异[校正平均差（95%CI），NEC-手术组：-46 g（-281，189），p = 0.70；NEC-药物组：-122 g（-308，63），p = 0.20]。
与未患该病的早产儿相比，接受手术和药物治疗的NEC早产儿足月时体重较低，这是由于ATV减少所致。这表明所接受的营养方案足以维持non-ATM，但不足以支持早产儿在妊娠晚期正常的脂肪组织沉积。
