Brewer E D
Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston 77030, USA.
Am J Kidney Dis. 1999 Jan;33(1):205-7. doi: 10.1016/s0272-6386(99)70285-4.
Good nutrition is necessary to maximize the potential for growth and development in the pediatric age-group, but children, like adults with chronic renal failure and end-stage renal disease, may be anorectic and eat poorly. Infants and adolescents are at special risk because of the intense demands of growth during the first 2 years of life and again during puberty. Neurodevelopment is also adversely affected by poor nutrition, especially in infants. Approximately two-thirds of pediatric dialysis patients are treated with chronic peritoneal dialysis, which results in significant protein losses in the dialysis effluent that can contribute to protein-calorie malnutrition. Meeting the nutritional needs of pediatric patients usually requires supplemental sources, such as intradialytic parenteral nutrition (IDPN) or tube feeding. Little is known about the effectiveness or desirability of IDPN in pediatric patients. More studies, especially of amino acid-based dialysis fluids for chronic peritoneal dialysis, need to be done before making IDPN a standard for pediatrics. Supplemental nasogastric or gastrostomy tube feedings have been very successful in maintaining and improving growth in infants, but no studies are available to evaluate their success in older children and adolescents. Recombinant growth hormone therapy, in addition to good nutrition and control of other growth factors such as acidosis, renal osteodystrophy, and chronic volume depletion, may be necessary for most growth-retarded children with chronic renal failure to achieve normal adult height.
良好的营养对于使儿科年龄段的生长发育潜力最大化至关重要，但儿童，就像患有慢性肾衰竭和终末期肾病的成年人一样，可能会食欲不振且饮食不佳。婴儿和青少年面临特殊风险，因为在生命的头两年以及青春期，生长需求旺盛。营养不佳也会对神经发育产生不利影响，尤其是在婴儿中。大约三分之二的儿科透析患者接受慢性腹膜透析治疗，这会导致透析液中有大量蛋白质流失，进而可能导致蛋白质 - 热量营养不良。满足儿科患者的营养需求通常需要补充营养来源，如透析期间胃肠外营养（IDPN）或管饲。关于IDPN在儿科患者中的有效性或适用性知之甚少。在将IDPN作为儿科标准之前，需要进行更多研究，尤其是关于用于慢性腹膜透析的氨基酸基透析液的研究。补充鼻饲或胃造口管饲在维持和改善婴儿生长方面非常成功，但尚无研究评估其在大龄儿童和青少年中的效果。除了良好的营养以及控制其他生长因素，如酸中毒、肾性骨营养不良和慢性容量耗竭外，对于大多数生长发育迟缓的慢性肾衰竭儿童，可能需要重组生长激素疗法才能达到正常成人身高。
