肠衰竭相关肝病婴儿和儿童经静脉用鱼油治疗后的生长情况。
Growth in Infants and Children With Intestinal Failure-associated Liver Disease Treated With Intravenous Fish Oil.
机构信息
Division of Gastroenterology, Hepatology and Nutrition.
Institutional Centers for Clinical and Translational Research.
出版信息
J Pediatr Gastroenterol Nutr. 2020 Feb;70(2):261-268. doi: 10.1097/MPG.0000000000002551.
BACKGROUND
Infants with intestinal failure (IF) and IF-associated liver disease (IFALD) are at risk for poor somatic growth because of increased metabolic demands, inadequate intake, intestinal malabsorption, chronic liver disease and other comorbidities. There are limited data on the nutritional adequacy of intravenous fish oil lipid emulsion (FOLE) compared with standard soybean oil lipid emulsion (SOLE) in the setting of intestinal failure.
AIMS
To describe growth patterns in a large cohort of infants with IFALD treated with FOLE.
METHODS
We compared growth data from infants enrolled in a single-center, prospective FOLE study to published norms, as well as to a multicenter, historical cohort of infants with IF treated with SOLE.
RESULTS
One hundred thirty-eight infants with IFALD were treated with FOLE and 108 with SOLE. Compared with normative growth curves from WHO and published preterm data, infants in both groups from 6 to 11 months postmenstrual age exhibited declines in mean weight- and length-for-age z scores. At 24 months postmenstrual age compared with WHO growth data, infants treated with FOLE had a mean (95% confidence interval [CI]) weight-for-age z-score of 0.13 (-0.18 to 0.45) and length-for-age z-score of 0.07 (-0.33 to 0.47). In comparison, at 24 months postmenstrual age, infants treated with SOLE had a mean weight for age z-score of -0.93 (-1.20 to -0.67) and mean length for age z-score of -2.33 (-2.75 to -1.91). Independent predictors of higher weight, length and head circumference z-scores included older postmenstrual age at baseline, fewer central line-associated blood stream infections, resolution of cholestasis, type of intravenous fat emulsion (FOLE vs SOLE) and female sex.
CONCLUSIONS
Infants with IFALD treated with FOLE showed comparable somatic growth to those treated with SOLE in early infancy, and improved somatic growth up to 24 months of age, supporting its wider use in this patient population.
背景
患有肠衰竭（IF）和与 IF 相关的肝病（IFALD）的婴儿由于代谢需求增加、摄入不足、肠吸收不良、慢性肝病和其他合并症，存在生长不良的风险。在肠衰竭的情况下，与标准大豆油脂肪乳剂（SOLE）相比，静脉内鱼油脂肪乳剂（FOLE）的营养充足性的数据有限。
目的
描述接受 FOLE 治疗的 IFALD 大队列婴儿的生长模式。
方法
我们将单中心前瞻性 FOLE 研究中纳入的婴儿的生长数据与 WHO 发布的生长标准和多中心历史队列中接受 SOLE 治疗的 IF 婴儿的生长数据进行比较。
结果
138 例 IFALD 婴儿接受 FOLE 治疗，108 例接受 SOLE 治疗。与 WHO 和已发表的早产儿数据的生长标准曲线相比，两组婴儿在 6 至 11 个月的校正月龄时体重和身长的年龄 Z 评分均下降。与 WHO 的生长数据相比，在 24 个月的校正月龄时，接受 FOLE 治疗的婴儿体重年龄 Z 评分的平均值（95%置信区间[CI]）为 0.13（-0.18 至 0.45），身高年龄 Z 评分的平均值为 0.07（-0.33 至 0.47）。相比之下，在 24 个月的校正月龄时，接受 SOLE 治疗的婴儿体重年龄 Z 评分的平均值为-0.93（-1.20 至-0.67），身高年龄 Z 评分的平均值为-2.33（-2.75 至-1.91）。体重、身高和头围 Z 评分较高的独立预测因素包括基线时校正月龄较大、中心静脉相关血流感染次数较少、胆汁淤积消退、静脉内脂肪乳剂类型（FOLE 与 SOLE）和女性。
结论
接受 FOLE 治疗的 IFALD 婴儿在婴儿早期的躯体生长与接受 SOLE 治疗的婴儿相当，在 24 个月时的躯体生长得到改善，支持在该患者人群中更广泛地使用 FOLE。
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