Benefits and Risks of Preprepared Parenteral Nutrition for Early Amino Acid Administration in Premature Infants with Very Low Birth Weight
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Administering early parenteral amino acids to very low birth weight (VLBW) premature infants (birth body weight [BBW]<1,500 g) is challenging due to factors such as holidays, cost, and access to sterile compounding facilities. Using advance-prepared parenteral nutrition (PN) may address this issue and should be evaluated for its safety and potential benefits. Methods: We extracted data from medical records collected between July 2015 and August 2019. VLBW infants received PN for at least seven days and were split into two groups: the traditional group (n=30), which initially received a glucose solution and then PN on workdays, and the pre-preparation group (n=16), which received advance-prepared PN immediately upon admission to the neonatal intensive care unit. Results: The median BBWs of the traditional and pre-preparation groups were 1,180.0 vs. 1,210.0 g. In the initial two days, the pre-preparation group had a significantly higher amino acid intake (2.23 and 2.24 g/kg/d) than the traditional group (0 and 1.78 g/kg/d). The pre-preparation group exhibited greater head circumference growth ratio relative to birth (7th day: 1.21% vs. −3.57%, p=0.014; 21st day: 7.71% vs. 3.31%, p=0.017). No significant differences in metabolic tolerance were observed. Conclusion: Advanced preparation of PN can be safely implemented in VLBW preterm infants, offering advantages such as early, higher amino acid intake and improved head circumference growth within the first 21 days post-birth. This strategy may serve as a viable alternative in settings where immediate provision of sterile compounding facilities is challenging.
Abstract
Purpose: Administering early parenteral amino acids to very low birth weight (VLBW) premature infants (birth body weight [BBW]<1,500 g) is challenging due to factors such as holidays, cost, and access to sterile compounding facilities. Using advance-prepared parenteral nutrition (PN) may address this issue and should be evaluated for its safety and potential benefits. Methods: We extracted data from medical records collected between July 2015 and August 2019. VLBW infants received PN for at least seven days and were split into two groups: the traditional group (n=30), which initially received a glucose solution and then PN on workdays, and the pre-preparation group (n=16), which received advance-prepared PN immediately upon admission to the neonatal intensive care unit. Results: The median BBWs of the traditional and pre-preparation groups were 1,180.0 vs. 1,210.0 g. In the initial two days, the pre-preparation group had a significantly higher amino acid intake (2.23 and 2.24 g/kg/d) than the traditional group (0 and 1.78 g/kg/d). The pre-preparation group exhibited greater head circumference growth ratio relative to birth (7th day: 1.21% vs. −3.57%, p=0.014; 21st day: 7.71% vs. 3.31%, p=0.017). No significant differences in metabolic tolerance were observed. Conclusion: Advanced preparation of PN can be safely implemented in VLBW preterm infants, offering advantages such as early, higher amino acid intake and improved head circumference growth within the first 21 days post-birth. This strategy may serve as a viable alternative in settings where immediate provision of sterile compounding facilities is challenging.
참고문헌 (26)
- Groh-Wargo S, "Enteral nutrition support of the preterm infant in the neonatal intensive care unit", Nutr Clin Pract, 24, pp.363~376 (2009)
- Dutta S, "Guidelines for feeding very low birth weight infants", Nutrients, 7, pp.423~442 (2015)
- Patel P, "Total parenteral nutrition for the very low birth weight infant", Semin Fetal Neonatal Med, 22, pp.2~7 (2017)
- van Goudoever JB, "ESPGHAN", ESPEN, CSPEN guidelines on pediatric parenteral nutrition : amino acids, pp.Clin Nutr, 2018[DOI]
- Clark RH, "Effects of two different doses of amino acid supplementation on growth and blood amino acid levels in premature neonates admitted to the neonatal intensive care unit : a randomized, controlled trial", Pediatrics, 120, pp.1286~1296 (2007)
- Trivedi A, "Early versus late administration of amino acids in preterm infants receiving parenteral nutrition", Cochrane Database Syst Rev, (7), pp.CD008771~ (2013)
- Osborn DA, "Higher versus lower amino acid intake in parenteral nutrition for newborn infants", Cochrane Database Syst Rev, 3, pp.CD005949~ (2018)
- "Pharmaceutical compounding – sterile preparations. General Chapter <797>" (2022)[URL]
- Denne SC, "Evidence supporting early nutritional support with parenteral amino acid infusion", Semin Perinatol, 31, pp.56~60 (2007)
- American Society of Health System Pharmacists, "ASHP guidelines on compounding sterile preparations", Am J Health Syst Pharm, 71, pp.145~166 (2014)
- Lapillonne A, "ESPGHAN", ESPEN, CSPEN guidelines on pediatric parenteral nutrition : lipids, pp.Clin Nutr, 2018[DOI]
- Mesotten D, "ESPGHAN", ESPEN, CSPEN guidelines on pediatric parenteral nutrition : carbohydrates, pp.Clin Nutr, 2018[DOI]
- Richardson DK, "SNAP-II and SNAPPE-II : simplified newborn illness severity and mortality risk scores", J Pediatr, 138, pp.92~100 (2001)
- Jadhav P, "Parenteral amino acid and metabolic acidosis in premature infants", JPEN J Parenter Enteral Nutr, 31, pp.278~283 (2007)
- Jarde A, "Vaginal birth vs caesarean section for extremely preterm vertex infants : a systematic review and meta-analyses", Arch Gynecol Obstet, 301, pp.447~458 (2020)
- Lee HC, "Low Apgar score and mortality in extremely preterm neonates born in the United States", Acta Paediatr, 99, pp.1785~1789 (2010)
- Cnattingius S, "Apgar score and risk of neonatal death among preterm infants", N Engl J Med, 383, pp.49~57 (2020)
- Dice JE, "Patent ductus arteriosus : an overview", J Pediatr Pharmacol Ther, 12, pp.138~146 (2007)
- Tang W, "Influence of respiratory distress syndrome on body composition after preterm birth", Arch Dis Child Fetal Neonatal Ed, 77, pp.F28~31 (1997)
- Chitale R, "Early enteral feeding for preterm or low birth weight infants : a systematic review and meta-analysis", Pediatrics, 150(Suppl 1), pp.e2022057092E~ (2022)
- Nangia S, "Early total enteral feeding versus conventional enteral feeding in stable very-low-birth-weight infants : a randomised controlled trial", Neonatology, 115, pp.256~262 (2019)
- Blanco CL, "Impact of early and high amino acid supplementation on ELBW infants at 2 years", J Pediatr Gastroenterol Nutr, 54, pp.601~607 (2012)
- Lin WT, "Predicting in-hospital length of stay for very-low-birth-weight preterm infants using machine learning techniques", J Formos Med Assoc, 121, pp.1141~1148 (2022)
- Morgan C, "Postnatal head growth in preterm infants : a randomized controlled parenteral nutrition study", Pediatrics, 133, pp.e120~8 (2014)
- te Braake FW, "Amino acid administration to premature infants directly after birth", J Pediatr, 147, pp.457~461 (2005)
- Heimler R, "The effects of early parenteral amino acids on sick premature infants", Indian J Pediatr, 77, pp.1395~1399 (2010)