극소 저체중 신생아의 예제제 정맥영양수액 공급에 의한 임상적 효과 평가
Clinical Efficacy of Starter Parenteral Nutrition in Very Low Birth Weight Infants
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Background : Preterm infants including very low birth weight infants (VLBWIs) and extremely low birth weight infants (ELBWIs) have high rates of protein turnover and low nutrient reserves. Therefore, parenteral nutrition (PN) should be initiated within 24 hours after birth if it is anticipated that they will be unable to tolerate enteral feeding for more than 2 to 3 days. However, in our institution, in cases of babies born on holidays and weekends, it is difficult to supply individualized PN including amino acids. So we supply starter PN (SPN) every Saturday and holiday, for use in case of emergency. We intended to evaluate the clinical efficacy of SPN on short-term growth and nutritional supply, especially for preterm infants. Methods : We retrospectively reviewed the medical records of preterm infants with a birth weight of less than 1,500 g who were born and admitted to the neonatal intensive care unit (NICU) of the Samsung Medical Center between March 2015 and May 2020. The patients were categorized into two groups according to whether they received SPN or not. We compared perinatal characteristics, nutrition supply, anthropometric measurements, and laboratory findings between the two groups. Results : Of the 82 patients, 40 infants were in the SPN group. Gestational age (p<0.001) and one minute Apgar score (p<0.001), and calories supplied over the first two weeks were lower in the SPN group (p=0.014). However, the rate of weight gain was higher in the SPN group (p=0.007). Most laboratory test results were significantly different between the two groups. Conclusion : SPN can improve the short-term growth of preterm infants. Lower gestational age seems to be the cause of relatively high values of laboratory test results including BUN and blood glucose as well as low caloric intake in the SPN group.
Abstract
Background : Preterm infants including very low birth weight infants (VLBWIs) and extremely low birth weight infants (ELBWIs) have high rates of protein turnover and low nutrient reserves. Therefore, parenteral nutrition (PN) should be initiated within 24 hours after birth if it is anticipated that they will be unable to tolerate enteral feeding for more than 2 to 3 days. However, in our institution, in cases of babies born on holidays and weekends, it is difficult to supply individualized PN including amino acids. So we supply starter PN (SPN) every Saturday and holiday, for use in case of emergency. We intended to evaluate the clinical efficacy of SPN on short-term growth and nutritional supply, especially for preterm infants. Methods : We retrospectively reviewed the medical records of preterm infants with a birth weight of less than 1,500 g who were born and admitted to the neonatal intensive care unit (NICU) of the Samsung Medical Center between March 2015 and May 2020. The patients were categorized into two groups according to whether they received SPN or not. We compared perinatal characteristics, nutrition supply, anthropometric measurements, and laboratory findings between the two groups. Results : Of the 82 patients, 40 infants were in the SPN group. Gestational age (p<0.001) and one minute Apgar score (p<0.001), and calories supplied over the first two weeks were lower in the SPN group (p=0.014). However, the rate of weight gain was higher in the SPN group (p=0.007). Most laboratory test results were significantly different between the two groups. Conclusion : SPN can improve the short-term growth of preterm infants. Lower gestational age seems to be the cause of relatively high values of laboratory test results including BUN and blood glucose as well as low caloric intake in the SPN group.
참고문헌 (25)
- 박원순, "초극소 저출생 체중아(≤1,000 g)에서 조기에 시작하는 정맥 영양 공급의 효과", Neonatal medicine, 18(1), pp.76~81 (2011), 대한신생아학회
- Denne SC, "Evidence supporting early nutritional support with parenteral amino acid infusion", Seminars in Perinatology, 31(2), pp.56~60 (2007)
- van Goudoever JB, "ESPGHAN", ESPEN, CSPEN guidelines on pediatric parenteral nutrition : Amino acids, pp.Clinical Nutrition, 2018[DOI]
- Valentine CJ, "Enhancing parenteral nutrition therapy for the neonate", Nutr Clin Pract, 22(2), pp.183~193 (2007)
- 장윤실, "초미숙아 생존 한계 극복 방안", Neonatal medicine, 20(3), pp.256~265 (2013), 대한신생아학회
- Merritt RJ, "The A.S.P.E.N. Nutrition Support Practice Manual", American Society for Parenteral and Enteral Nutrition, ~ (2005)
- Thureen PJ, "Neonatal Nutrition and Metabolism" (2006), Cambridge University Press
- van den Akker CH, "Effects of early amino acid administration on leucine and glucose kinetics in premature infants", Pediatr Res, 59(5), pp.732~735 (2006)
- Adamkin DH, "Nutrition Management of the Very Low-birthweight Infant. II", Optimizing Enteral Nutrition and Postdischarge Nutrition, 7(12), pp.e608~e614 (2006)
- Poindexter BB, "Early provision of parenteral amino acids in extremely low birth weight infants : relation to growth and neurodevelopmental outcome", J Pediatr, 148(3), pp.300~305 (2006)
- Stephens BE, "First-week protein and energy intakes are associated with 18-month developmental outcomes in extremely low birth weight infants", Pediatrics, 123(5), pp.1337~1343 (2009)
- van den Akker CH, "Obser vational outcome results following a randomized controlled trial of early amino acid administration in preterm infants", J Pediatr Gastroenterol Nutr, 59(6), pp.714~719 (2014)
- Simmer K, "Standardised parenteral nutrition", Nutrients, 5(4), pp.1058~1070 (2013)
- Ayers P, "A.S.P.E.N. parenteral nutrition safety consensus recommendations", JPEN. Journal of Parenteral and Enteral Nutrition, 38(3), pp.296~333 (2014)
- Koletzko B, "1. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR)", Journal of Pediatric Gastroenterology and Nutrition, 41(Suppl 2), pp.S1~S87 (2005)
- Martin RJ, "Fanaroff and Martin’s Neonatal-Perinatal Medicine, 2-Volume Set: Diseases of the Fetus and Infant" (2020), Elsevier
- Bonsante F, "Initial Amino Acid Intake Influences Phosphorus and Calcium Homeostasis in Preterm Infants – It Is Time to Change the Composition of the Early Parenteral Nutrition", PLOS ONE, 8(8), pp.e72880~ (2013)
- Sung SI, "Increased risk of refeeding syndrome–like hypophosphatemia with high initial amino acid intake in smallfor-gestational-age, extremely-lowbirthweight infants", PLOS ONE, 14(8), pp.e0221042~ (2019)
- Igarashi A, "Risk Factors for the Development of Refeeding Syndrome-Like Hypophosphatemia in Very Low Birth Weight Infants", Disease markers, 2017, pp.9748031~ (2017)
- Ridout E, "Blood Urea Nitrogen Concentration as a Marker of Amino-Acid Intolerance in Neonates with Birthweight Less than 1250 g", Journal of Perinatology, 25(2), pp.130~133 (2005)
- Thureen PJ, "Effect of Low versus High Intravenous Amino Acid Intake on Very Low Birth Weight Infants in the Early Neonatal Period", Pediatric Research, 53(1), pp.24~32 (2003)
- Hey E, "Hyperglycaemia and the very preterm baby", Semin Fetal Neonatal Med, 10(4), pp.377~387 (2005)
- Beardsall K, "The continuous glucose monitoring sensor in neonatal intensive care. Archives of disease in childhood", Fetal and neonatal edition, 90(4), pp.F307~F310 (2005)
- Mesotten D, "ESPGHAN", ESPEN, CSPEN guidelines on pediatric parenteral nutrition : Carbohydrates, pp.Clin Nutr, 2018[DOI]
- 안혜림, "초기 고용량 아미노산 공급이 미숙아의 영양상태에 미치는 효과 평가", 병원약사회지, 38(1), pp.52~64 (2021), 한국병원약사회[DOI]