Pediatric Nutrition Support, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA.
Quantitative Health Sciences, Learner Research Institute, Cleveland, Ohio, USA.
Nutr Clin Pract. 2020 Aug;35(4):724-728. doi: 10.1002/ncp.10365. Epub 2019 Jul 3.
Copper (Cu) is an essential trace element, with deficiency causing anemia, neutropenia, and other abnormalities. Cu is mainly absorbed in the small intestine. Patients with intestinal failure or jejunostomy have increased Cu losses and require additional Cu supplementation in parenteral nutrition (PN). The American Society for Clinical Nutrition standards for trace element recommendations in PN, including Cu, were created in 1988, and the American Society for Parenteral and Enteral Nutrition currently follows the same recommendations.
Patients admitted to the neonatal intensive care unit for surgical intervention resulting in an ostomy (ileal or jejunal) were included in this retrospective study. Patients received PN support with Cu dosed individually, rather than in a multi-trace element package. Cu and ostomy output were analyzed daily. Serum Cu was obtained 2 months postsurgical intervention.
Out of the 7 patients enrolled, 71% had low serum Cu. Weekly mean Cu intake for all 7 patients ranged from 5.3 to 154.8 μg/kg/day from enteral and parenteral sources, with individual mean weekly Cu intake ranging from 18.9 to 74.4 μg/kg/day from surgical intervention to 2 months post-surgery. Patients' weekly ostomy outputs ranged from 0 mL/kg/day to 77.2 mL/kg/day, with individual mean weekly output ranging from 3.7 to 41.6 mL/kg/day.
Providing 20 μg/kg/day of Cu in PN to neonates with ostomies is insufficient to prevent Cu deficiency. Further studies are warranted to determine an optimal dosage of parenteral Cu to prevent Cu deficiency.
铜（Cu）是一种必需的微量元素，缺乏会导致贫血、中性粒细胞减少症和其他异常。Cu 主要在小肠中被吸收。患有肠衰竭或空肠造口术的患者会增加 Cu 丢失，需要在肠外营养（PN）中额外补充 Cu。美国临床营养学会（American Society for Clinical Nutrition）于 1988 年制定了 PN 中微量元素（包括 Cu）推荐标准，美国肠外与肠内营养学会（American Society for Parenteral and Enteral Nutrition）目前也遵循相同的建议。
本回顾性研究纳入了因手术干预而导致造口（回肠或空肠）的新生儿重症监护病房（neonatal intensive care unit）患者。患者接受 PN 支持，Cu 单独给药，而非在多元素包中给药。每天分析 Cu 摄入量和造口排出量。术后 2 个月时测定血清 Cu。
在纳入的 7 例患者中，71%的患者血清 Cu 水平较低。7 例患者的每周平均 Cu 摄入量（来自肠内和肠外途径）均为 5.3 至 154.8μg/kg/天，从手术干预到术后 2 个月，个体的每周平均 Cu 摄入量范围为 18.9 至 74.4μg/kg/天。患者的每周造口排出量范围为 0 至 77.2mL/kg/天，个体的每周平均排出量范围为 3.7 至 41.6mL/kg/天。
向有造口的新生儿 PN 中提供 20μg/kg/天的 Cu 不足以预防 Cu 缺乏。需要进一步研究确定预防 Cu 缺乏的最佳 PN 中 Cu 剂量。
