Perth Children's Hospital, Pharmacy Department, Nedlands, WA, Australia.
The University of Western Australia, Medical School, Perth, WA, Australia.
Br J Nutr. 2022 Jul 14;128(1):131-138. doi: 10.1017/S0007114521003020. Epub 2021 Aug 11.
There is limited information regarding the use of parenteral nutrition (PN) in term and late preterm infants. We conducted a survey to study the current clinical practices within Australia and New Zealand (ANZ). A fifteen-question online survey was distributed to 232 neonatologists and fifty-five paediatric intensivists across ANZ between September and November 2019. At least one neonatologist from twenty-seven out of thirty tertiary neonatal intensive care units responded (90 %). Responses were received from sixty-nine neonatologists (30 %) and seven paediatric intensivists (13 %). The overall response rate was 26 % (76/287). Thirty-three percent (25/76) commenced PN within 24 h of admission, 27 % (20/75) between 24 and 48 h, 24 % (18/75) between 48 and 72 h, 9 % (7/75) between 72 and 96 h and 4 % (3/75) between 96 h and 7 days. None of the respondents commenced PN after 7 d of admission. Sixty-one percent (46/75) aimed for 1·5-3 g/kg per d of parenteral amino acids, whereas 27 % (20/75) aimed for 2-3 g/kg per d. Renal failure (59 %; 38/64) and high plasma urea (44 %; 28/64) were the major indications for withholding/decreasing the amino acid intake. Eighty-three percent (63/76) aimed for a dose of 2·5g-3·5 g/kg per d of parenteral lipids; about 9 % (7/76) targeted a dose of 1-2·5 g/kg per d and 4 % (3/76) for > 3·5 g/kg per d. Thirty-two percent (24/74) reported that they would withhold/decrease the dose of parenteral lipids in infants with sepsis. The variations in clinicians' practices with respect to the use of PN in term and late preterm infants highlight the need for high-quality research in this population.
关于肠外营养（PN）在足月和晚期早产儿中的应用，相关信息有限。我们进行了一项调查，以研究澳大利亚和新西兰（ANZ）的当前临床实践。2019 年 9 月至 11 月，我们向 ANZ 的 232 名新生儿科医生和 55 名儿科重症监护医生分发了一份包含 15 个问题的在线调查问卷。在 30 个三级新生儿重症监护病房中，至少有一名新生儿科医生做出了回应（90%）。共有 69 名新生儿科医生（30%）和 7 名儿科重症监护医生（13%）做出了回应。总的回应率为 26%（76/287）。33%（25/76）的医生在入院后 24 小时内开始 PN，27%（20/75）在 24-48 小时内，24%（18/75）在 48-72 小时内，9%（7/75）在 72-96 小时内，4%（3/75）在 96 小时至 7 天内。没有任何一个受访者在入院后 7 天以上开始 PN。61%（46/75）的目标是每天每公斤体重给予 1.5-3g 的肠外氨基酸，而 27%（20/75）的目标是每天每公斤体重给予 2-3g。肾衰竭（59%；38/64）和高血浆尿素（44%；28/64）是停止/减少氨基酸摄入的主要指征。83%（63/76）的目标是每天每公斤体重给予 2.5-3.5g 的肠外脂肪乳剂；约 9%（7/76）的目标是每天每公斤体重给予 1-2.5g，4%（3/76）的目标是每天每公斤体重给予 >3.5g。32%（24/74）的医生报告称，他们会在患有败血症的婴儿中停止/减少肠外脂肪乳剂的剂量。在足月和晚期早产儿中使用 PN 的临床医生实践存在差异，这突出表明需要对这一人群进行高质量的研究。
