足月和晚期早产儿的当前肠外营养实践和临床结局：一项回顾性研究。

Current parenteral nutrition practice and clinical outcomes of term and late preterm infants: A retrospective study.

机构信息

Perth Children's Hospital, Pharmacy Department, Nedlands, WA, Australia; The University of Western Australia, Medical School, Perth, WA, Australia.

Telethon Kids Institute, Nedlands, WA, Australia.

出版信息

Clin Nutr ESPEN. 2023 Jun;55:178-184. doi: 10.1016/j.clnesp.2023.03.010. Epub 2023 Mar 17.

DOI:10.1016/j.clnesp.2023.03.010

PMID:37202043

Abstract

BACKGROUND AND AIMS

Limited studies have described parenteral nutrition (PN) practices and clinical outcomes in term and late preterm infants. The aim of this study was to describe the current practice of PN in term and late preterm infants and their short-term clinical outcomes.

METHODS

We conducted a retrospective study in a tertiary NICU between October 2018 and September 2019. Infants (gestation ≥34 weeks) admitted on the day of birth or the following day and received PN were included. We collected data on patient characteristics, daily nutrition, clinical and biochemical outcomes until discharge.

RESULTS

A total of 124 infants [mean (SD) gestation: 38 (1.92) weeks] were included; 115 (93%) and 77 (77%) commenced on parenteral amino acids and lipids, respectively, by day 2 of admission. The mean parenteral amino acid and lipid intake on day 1 of admission was 1.0 (0.7) g/kg/day and 0.8 (0.6) g/kg/day respectively and increased to 1.5 (1.0) g/kg/day and 2.1 (0.7) g/kg/day by day 5, respectively. Eight (6.5%) infants accounted for 9 episodes of hospital-acquired infections. The mean z-scores for anthropometrics at discharge were significantly lower than at birth (Weight: -0.72 (1.13) vs - 0.04 (1.11); p < 0.001; Head circumference: -0.14 (1.17) vs 0.34 (1.05); p < 0.001; Length: -0.17 (1.69) vs 0.22 (1.34); p < 0.001). A total of 28 (22.6%) and 16 (12.9%) infants had mild and moderate postnatal growth restriction (PNGR), respectively. None had severe PNGR. Thirteen infants (11%) experienced hypoglycaemia, whereas 53 (43%) experienced hyperglycaemia.

CONCLUSION

The intakes of parenteral amino acids and lipids in term and late preterm infants were at the lower end of the currently recommended doses, especially in the first five days of admission. One third of the study population had mild to moderate PNGR. Randomised trials investigating the impact of initial PN intakes on clinical, growth and developmental outcomes are recommended.

摘要

背景与目的

仅有少数研究描述了足月和晚期早产儿的肠外营养（PN）实践和临床结局。本研究旨在描述足月和晚期早产儿 PN 的当前实践及其短期临床结局。

方法

我们在 2018 年 10 月至 2019 年 9 月期间在一家三级新生儿重症监护病房进行了一项回顾性研究。纳入出生当天或次日接受 PN 的婴儿（胎龄≥34 周）。收集患者特征、每日营养、临床和生化结局直至出院的数据。

结果

共纳入 124 例婴儿[平均（SD）胎龄：38（1.92）周]；分别有 115（93%）例和 77（77%）例婴儿在入院第 2 天开始接受肠外氨基酸和脂肪。入院第 1 天的平均肠外氨基酸和脂肪摄入量分别为 1.0（0.7）g/kg/d 和 0.8（0.6）g/kg/d，分别增加至第 5 天的 1.5（1.0）g/kg/d 和 2.1（0.7）g/kg/d。8（6.5%）例婴儿发生 9 例医院获得性感染。出院时人体测量学的 z 评分明显低于出生时（体重：-0.72（1.13）比-0.04（1.11）；p<0.001；头围：-0.14（1.17）比 0.34（1.05）；p<0.001；身长：-0.17（1.69）比 0.22（1.34）；p<0.001）。共有 28（22.6%）例和 16（12.9%）例婴儿分别有轻度和中度出生后生长受限（PNGR），无严重 PNGR。13（11%）例婴儿发生低血糖，53（43%）例婴儿发生高血糖。