Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA,
Division of Neonatology, Department of Pediatrics, School of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Neonatology. 2023;120(2):242-249. doi: 10.1159/000527552. Epub 2023 Feb 22.
The objective of this study was to determine the feasibility and safety of enhanced early (PN) (early initiation of intralipids and faster advancement of glucose infusion rate) during the first week of life for very low birth weight (VLBW) preterm infants.
90 VLBW preterm infants (<32 weeks gestational age at birth) admitted to the University of Minnesota Masonic Children's Hospital between August 2017 and June 2019 were included. Enrolled infants were stratified by gestational age-groups and randomized to either the enhanced nutrition protocol (intervention group) or the standard PN protocol (standard group). Welch's two-sample t tests were used to investigate differences in calorie and protein intake, insulin use, days of hyperglycemia, hyperbilirubinemia, and hypertriglyceridemia, and proportion of bronchopulmonary dysplasia, necrotizing enterocolitis, and death between groups.
Intervention and standard groups were similar in baseline characteristics. The intervention group received higher weekly mean caloric intake (102.6 [SD 24.9] kcal/kg/day versus 89.7 [SD 30.2] kcal/kg/day; p = 0.001) and higher mean caloric intake on days of life 2-4 (p < 0.05 for all). Both groups received the recommended protein intake (≥4 g/kg/day). There were no significant differences in safety or feasibility outcomes between groups (all p values >0.12).
Utilization of an enhanced nutrition protocol during the first week of life resulted in increased caloric intake and was feasible with no evidence of harm. Follow-up of this cohort is needed to determine if enhanced PN will result in improved growth and neurodevelopment.
本研究旨在确定在生命的第一周内对极低出生体重（VLBW）早产儿进行强化早期（PN）（尽早开始输注脂肪乳剂和更快地提高葡萄糖输注率）的可行性和安全性。
纳入 2017 年 8 月至 2019 年 6 月期间在明尼苏达大学梅森儿童医院就诊的 90 名 VLBW 早产儿（出生时胎龄<32 周）。根据胎龄分组，将入组婴儿分为强化营养方案（干预组）或标准 PN 方案（标准组）。采用 Welch 两样本 t 检验比较两组间热量和蛋白质摄入、胰岛素使用、高血糖天数、高胆红素血症天数、高甘油三酯血症天数以及支气管肺发育不良、坏死性小肠结肠炎和死亡率的差异。
干预组和标准组在基线特征方面相似。干预组每周平均热量摄入较高（102.6 [SD 24.9] kcal/kg/day 比 89.7 [SD 30.2] kcal/kg/day；p=0.001），生命第 2-4 天的平均热量摄入也更高（所有 p 值均<0.05）。两组均接受了推荐的蛋白质摄入量（≥4 g/kg/day）。两组在安全性或可行性结局方面均无显著差异（所有 p 值均>0.12）。
在生命的第一周内使用强化营养方案可增加热量摄入，且可行，无不良事件发生。需要对该队列进行随访，以确定强化 PN 是否会改善生长和神经发育。
