Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy.
Department of Maternal and Child Health, University of Rome La Sapienza, Rome, Italy.
Nutrition. 2021 Sep;89:111219. doi: 10.1016/j.nut.2021.111219. Epub 2021 Feb 26.
Preterm births are at higher risk for neurodevelopment (NDV) disabilities. To limit long-term consequences, guidelines recommend aggressive parenteral nutrition (PN) soon after birth. The aim of this study was to examine the effects of energy-enhanced PN in the first week of life on long-term NDV in preterm neonates.
We compared two cohorts of newborns (group A: energy-enhanced PN and group B: energy-standard PN) with different energy intake in the first 7 d of life (DoL) given by PN with the same protein amount, to study the influences of an energy-enhanced PN on NDV at 24 mo of life evaluated with the Bayley Scale of Infant Development-III edition.
We analyzed 51 newborns (A: n = 24 versus B: n = 27). The two cohorts were similar in baseline characteristics (gestational age group A 29 wk, 95% confidence interval [CI], 28-30 wk versus group B 29 wk, 95% CI, 28-30 wk; birth weight A: 1214 g, 95% CI, 1062-1365 g versus B 1215 g, 95% CI, 1068-1363 g; boys A 62.5% versus B 55.6%). Infants in cohort B showed significantly (P < 0.05) better gross motor, total scaled, and total composite motor scores (A: 8 (1) versus B 9 (2); A 17 (4) versus B 19 (5); A 91 (12) versus B 97 (15); respectively). Cohort A showed a higher percentage of infants with delayed socioemotional competence (A 30.4% versus B 7.7%, P < 0.05). No differences were found in growth parameters at 24 mo of life. Linear regression analysis showed that socioemotional competence and motor score were negatively associated with energy intake of the first 7 DoL given by PN.
A more aggressive PN strategy results in lower motor score and socioemotional competence performance at 24 mo of life. More caution might be advocated for an energy-enhanced PN protocol, particularly in neonates with lower birth weight, for long-term NDV in preterm neonates.
早产儿发生神经发育障碍（NDV）的风险更高。为了限制长期后果，指南建议在出生后尽快进行积极的肠外营养（PN）。本研究的目的是研究出生后第一周内给予能量增强型 PN 对早产儿长期 NDV 的影响。
我们比较了两组新生儿（A 组：能量增强型 PN；B 组：能量标准型 PN），在生命的前 7 天（DoL）给予 PN 时，能量摄入量不同（A 组的 PN 提供的能量和蛋白质与 B 组相同），研究能量增强型 PN 对 24 月龄时用贝利婴幼儿发育量表 III 版评估的 NDV 的影响。
我们分析了 51 名新生儿（A 组：n=24 例，B 组：n=27 例）。两组在基线特征方面相似（A 组胎龄 29 周，95%置信区间 [CI]：28-30 周，B 组 29 周，95%CI：28-30 周；A 组出生体重 1214g，95%CI：1062-1365g，B 组 1215g，95%CI：1068-1363g；A 组男婴 62.5%，B 组 55.6%）。B 组的婴儿在粗大运动、总评分和总综合运动评分方面明显（P<0.05）更好（A：8（1）比 B：9（2）；A：17（4）比 B：19（5）；A：91（12）比 B：97（15））。A 组中社会情感能力延迟的婴儿比例更高（A：30.4%比 B：7.7%，P<0.05）。24 个月时的生长参数无差异。线性回归分析表明，社会情感能力和运动评分与 PN 在前 7 天给予的能量摄入呈负相关。
更积极的 PN 策略会导致 24 个月时运动评分和社会情感能力降低。对于早产儿，特别是出生体重较低的早产儿，在长期 NDV 方面，对能量增强型 PN 方案需要更加谨慎。
