Cochran E B, Phelps S J, Helms R A
Department of Clinical Pharmacy, University of Tennessee, Memphis.
Clin Pharm. 1988 May;7(5):351-66.
Protein, calorie, fluid, fat, and micronutrient requirements of pediatric patients are reviewed, as are methods of nutritional assessment and complications associated with the use of parenteral nutrition in these patients. In general, preterm infants and neonates require greater per-kilogram amounts of protein, calories, fluid, and micronutrients than older children. In addition, preterm infants and neonates have deficiencies in enzymes that metabolize certain amino acids, making otherwise nonessential amino acids essential. These unique protein needs have been addressed in amino acid formulations designed specifically for this group of patients. Supplying the neonate with the calcium and phosphorus needed for bone growth can be difficult because of solubility limitations in parenteral nutrient solutions. The use of intravenous fat emulsion in infants with hyperbilirubinemia or pulmonary complications is controversial. However, only rarely does fat emulsion have to be completely withheld. Complications associated with parenteral nutrition in pediatric patients include infection, metabolic disorders (cholestasis, bone demineralization), and mechanical problems. Cholestasis induced by parenteral nutrition has been shown to be more common in low-birth-weight infants; however, the precise etiology is unknown and may be multifactorial. Basic requirements necessary to promote growth while pediatric patients are receiving parenteral nutrition have been determined. However, current studies are challenging what were thought to be standards of pediatric parenteral nutrition therapy.
本文回顾了儿科患者的蛋白质、热量、液体、脂肪和微量营养素需求，以及营养评估方法和这些患者使用肠外营养相关的并发症。一般来说，早产儿和新生儿每公斤所需的蛋白质、热量、液体和微量营养素比大龄儿童更多。此外，早产儿和新生儿缺乏代谢某些氨基酸的酶，这使得原本非必需的氨基酸变得必需。专门为这类患者设计的氨基酸配方已考虑到这些独特的蛋白质需求。由于肠外营养液中的溶解度限制，为新生儿提供骨骼生长所需的钙和磷可能会很困难。在患有高胆红素血症或肺部并发症的婴儿中使用静脉脂肪乳存在争议。然而，完全停用脂肪乳的情况很少见。儿科患者肠外营养相关的并发症包括感染、代谢紊乱（胆汁淤积、骨质脱矿）和机械问题。肠外营养引起的胆汁淤积在低体重婴儿中更为常见；然而，确切病因尚不清楚，可能是多因素的。已经确定了儿科患者接受肠外营养时促进生长所需的基本要求。然而，目前的研究正在挑战人们曾经认为的儿科肠外营养治疗标准。
