Cubillos Celis María Paz, Mena Nannig Patricia
Complejo Asistencial Dr. Sótero del Río, Santiago, Chile,
Complejo Asistencial Dr. Sótero del Río, Santiago, Chile.
Rev Chil Pediatr. 2018 Feb;89(1):10-17. doi: 10.4067/S0370-41062018000100010.
New nutritional approaches to treat extreme premature babies have demonstrated relevant eviden ce of metabolic disturbances with early hypophosphatemia, especially in patients with intrauterine growth restriction (IUGR). They have shown late hypophosphatemia, as well, which is characteristic in the metabolic bone disease. A sytematic search of literature describing metabolic disturbances of phosphorus in preterm newborns is presented, related to the use of early parenteral nutrition and also in the context of metabolic bone disease. The articles were gathered from electronic data bases, such as PubMed and Rima. We include articles in english and spanish which were selected by titles and abstracts. Several strategies for early nutrition have been proposed in order to ensure an adequate amount of nutrients to accomplish the development and growth of preterm babies. Patients with parenteral nutrition support with different doses of phosphate, or inadequate calcium phosphate relation, or an increased amino acid content, may present hypophosphatemia, hypercalcemia, hy pomagnesemia, hypokalemia and hyperglycemia, all of these are additionally noteworthy in the pre sence of intrauterine growth restriction. Furthermore, said alterations are associated with prolonged mechanical ventilation, as well as bronchopulmonary dysplasia and increase in late onset sepsis. The late hypophosphatemia, described several years ago, arises as normocalcemia and as an increment of alkaline phosphatases in the metabolic bone disease in preterm babies, and also with an inadequate mineralization in different grades, secondary to an inadequate supply due to high nutritional requi rements in these patients. When early or late hypophosphatemia appears in preterm babies, it shall require timely control of phosphemia and will need to adjust the nutritional intake in order to correct it. In case of preterm babies with early parenteral nutrition it will also need a control of calcemia in the first week of birth, especially if those belonging to the IUGR group. Adjustment must be made along with metabolic follow up, as well. In late hypophosphatemia, a weekly or every two weeks fo llow up will be a must for all preterm babies in risk and they should be given supplements to get an optimum mineral supply.
治疗极早早产儿的新营养方法已证明存在与早期低磷血症相关的代谢紊乱的相关证据，尤其是在宫内生长受限（IUGR）的患者中。它们还表现出晚期低磷血症，这是代谢性骨病的特征。本文介绍了对描述早产儿磷代谢紊乱的文献进行的系统检索，这些紊乱与早期肠外营养的使用以及代谢性骨病的背景有关。文章从电子数据库中收集，如PubMed和Rima。我们纳入了通过标题和摘要筛选出的英文和西班牙文文章。为确保提供足够的营养以促进早产儿的发育和生长，已提出了几种早期营养策略。接受不同剂量磷酸盐的肠外营养支持、钙磷比例不当或氨基酸含量增加的患者，可能会出现低磷血症、高钙血症、低镁血症、低钾血症和高血糖症，在存在宫内生长受限的情况下，所有这些情况都格外值得关注。此外，上述改变与机械通气时间延长、支气管肺发育不良以及晚发性败血症增加有关。数年前描述的晚期低磷血症，表现为早产儿代谢性骨病中的血钙正常和碱性磷酸酶升高，并且由于这些患者营养需求高导致供应不足，还伴有不同程度的矿化不足。当早产儿出现早期或晚期低磷血症时，需要及时控制血磷水平，并需要调整营养摄入量以纠正它。对于接受早期肠外营养的早产儿，在出生后的第一周还需要控制血钙水平，特别是对于IUGR组的婴儿。还必须进行代谢随访并做出调整。在晚期低磷血症中，所有有风险的早产儿必须每周或每两周进行一次随访，并应给予补充剂以获得最佳的矿物质供应。
