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胆碱补充剂在早产儿中的应用：一项系统综述。

The use of choline supplementation in premature newborns: a systematic review.

作者信息

Rodrigues Ligia Modelli, Oliveira Allan Chiaratti de, Konstantyner Tulio

机构信息

Universidade Federal de São Paulo, São Paulo, SP, Brazil.

出版信息

Rev Paul Pediatr. 2025 Aug 8;43:e2024214. doi: 10.1590/1984-0462/2025/43/2024214. eCollection 2025.

DOI:10.1590/1984-0462/2025/43/2024214
PMID:40802301
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12334154/
Abstract

OBJECTIVE

To identify the routes and doses of choline supplementation required to meet the metabolic demands of preterm infants.

DATA SOURCE

The information was searched in three databases: US National Library of Medicine National Institute of Health (PubMed), Scientific Electronic Library Online (SciELO) and Web of Science. The search for articles was updated in August 2024, with no restrictions on publication year or language. This review was registered in the International Prospective Register of Systematic Reviews - PROSPERO (ID: 549568).

DATA SYNTHESIS

The final selection of studies yielded eight original articles, which were subsequently evaluated for their methodological quality. The recommended dosage of parenteral choline remains uncertain. However, studies have demonstrated a reduction in serum choline level inversely proportional to the quantity administered via parenteral nutrition, particularly in preterm infants with slow progression to enteral nutrition. The dose of 40-50 mg/kg/day of enteral choline appears to be sufficient to maintain plasmatic levels at a concentration comparable to that observed in the umbilical cord of preterm infants.

CONCLUSIONS

The need for daily choline supplementation from the first day of life is still controversial. The results of the selected studies do not allow for the determination of the optimal choline dosage for parenteral nutrition in these infants. Nevertheless, there is some scientific evidence suggesting that providing 40-50 mg/kg/day enterally is sufficient to meet the metabolic needs of preterm infants.

摘要

目的

确定满足早产儿代谢需求所需的胆碱补充途径和剂量。

数据来源

在三个数据库中进行信息检索：美国国立医学图书馆国立卫生研究院（PubMed）、科学电子图书馆在线（SciELO）和科学引文索引（Web of Science）。文章检索于2024年8月更新，对出版年份和语言无限制。本综述已在国际前瞻性系统评价注册库-PROSPERO（注册号：549568）中注册。

数据综合

最终筛选出八项原创性文章，随后对其方法学质量进行评估。肠外胆碱的推荐剂量仍不确定。然而，研究表明血清胆碱水平的降低与通过肠外营养给予的量成反比，尤其是在肠内营养进展缓慢的早产儿中。40-50mg/kg/天的肠内胆碱剂量似乎足以将血浆水平维持在与早产儿脐带中观察到的浓度相当的水平。

结论

从出生第一天起每日补充胆碱的必要性仍存在争议。所选研究的结果无法确定这些婴儿肠外营养的最佳胆碱剂量。尽管如此，有一些科学证据表明，每天经肠道提供40-50mg/kg足以满足早产儿的代谢需求。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dc90/12334154/b1d7374d071c/1984-0462-rpp-43-e2024214-gf03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dc90/12334154/3c907ab352b2/1984-0462-rpp-43-e2024214-gf01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dc90/12334154/43985d41f978/1984-0462-rpp-43-e2024214-gf02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dc90/12334154/b1d7374d071c/1984-0462-rpp-43-e2024214-gf03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dc90/12334154/3c907ab352b2/1984-0462-rpp-43-e2024214-gf01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dc90/12334154/43985d41f978/1984-0462-rpp-43-e2024214-gf02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dc90/12334154/b1d7374d071c/1984-0462-rpp-43-e2024214-gf03.jpg

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本文引用的文献

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Choline-An Underappreciated Component of a Mother-to-Be's Diet.胆碱——孕妇饮食中被低估的成分。
Nutrients. 2024 Jun 5;16(11):1767. doi: 10.3390/nu16111767.
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Advancing nutrition science to meet evolving global health needs.推进营养科学以满足不断变化的全球健康需求。
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Choline supplements: An update.胆碱补充剂：更新。
Front Endocrinol (Lausanne). 2023 Mar 7;14:1148166. doi: 10.3389/fendo.2023.1148166. eCollection 2023.
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Choline Kinetics in Neonatal Liver, Brain and Lung-Lessons from a Rodent Model for Neonatal Care.胆碱在新生儿肝脏、大脑和肺中的动力学变化——以新生儿护理的啮齿动物模型为基础的研究。
Nutrients. 2022 Feb 8;14(3):720. doi: 10.3390/nu14030720.
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Habitual Choline Intakes across the Childbearing Years: A Review.育龄期习惯性胆碱摄入量：综述。
Nutrients. 2021 Dec 8;13(12):4390. doi: 10.3390/nu13124390.
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Postnatal adaptations of phosphatidylcholine metabolism in extremely preterm infants: implications for choline and PUFA metabolism.极早产儿出生后磷脂酰胆碱代谢的适应性变化：对胆碱和多不饱和脂肪酸代谢的影响
Am J Clin Nutr. 2020 Dec 10;112(6):1438-1447. doi: 10.1093/ajcn/nqaa207.
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Serum choline in extremely preterm infants declines with increasing parenteral nutrition.极早产儿的血清胆碱水平会随着肠外营养的增加而下降。
Eur J Nutr. 2021 Mar;60(2):1081-1089. doi: 10.1007/s00394-020-02312-2. Epub 2020 Jun 25.
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Choline: Exploring the Growing Science on Its Benefits for Moms and Babies.胆碱：探索其对妈妈和宝宝益处的不断发展的科学。
Nutrients. 2019 Aug 7;11(8):1823. doi: 10.3390/nu11081823.
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Choline: The Neurocognitive Essential Nutrient of Interest to Obstetricians and Gynecologists.胆碱：妇产科医生关注的神经认知必需营养素。
J Diet Suppl. 2020;17(6):733-752. doi: 10.1080/19390211.2019.1639875. Epub 2019 Aug 6.
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Combined choline and DHA supplementation: a randomized controlled trial.联合胆碱和二十二碳六烯酸补充剂：一项随机对照试验。
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