多种油脂肪乳在超低出生体重儿中应用的疗效分析

林慧佳; 沈晓霞; 倪映华; 马晓路; 施丽萍; 杜立中

doi:10.7499/j.issn.1008-8830.2011029

PDF(1356 KB)

HTML

中国当代儿科杂志 ›› 2021, Vol. 23 ›› Issue (3) : 229-235. DOI: 10.7499/j.issn.1008-8830.2011029

论著·临床研究

多种油脂肪乳在超低出生体重儿中应用的疗效分析

林慧佳, 沈晓霞, 倪映华, 马晓路, 施丽萍, 杜立中

作者信息 +

Clinical effect of multi-oil fat emulsion for parenteral nutrition support in extremely low birth weight infants

LIN Hui-Jia, SHEN Xiao-Xia, NI Ying-Hua, MA Xiao-Lu, SHI Li-Ping, DU Li-Zhong

Author information +

文章历史 +

摘要

目的分析多种油脂肪乳（SMOF）在超低出生体重（ELBW）儿中应用的疗效。方法回顾性选取2018年1月1日至2020年7月30日收治的ELBW儿49例为研究对象，入院时日龄≤14 d，接受胃肠外营养时间 > 14 d。根据应用的脂肪乳剂种类，分为SMOF组（n=26）和中长链脂肪乳（MCT/LCT）组（n=23），比较两组患儿间临床特征、并发症发生情况、营养支持治疗及相关结局。结果 49例患儿平均出生体重为（892±83）g，平均出生胎龄为（28.2±2.3）周。两组间血流动力学意义的动脉导管未闭、脑室内出血、新生儿坏死性小肠结肠炎、早产儿视网膜病变、支气管肺发育不良（BPD）、BPD Ⅲ度、败血症、肺炎等并发症发生率比较差异均无统计学意义（P > 0.05）。两组间胃肠外营养应用时间、达全肠内营养日龄及出院时头围、身长、体重等比较差异均无统计学意义（P > 0.05）。共有22例（45%）患儿发生胃肠外营养相关性胆汁淤积症（PNAC），其中SMOF组13例（50%），MCT/LCT组9例（39%），两组间比较差异无统计学意义（P > 0.05）；但SMOF组PNAC患儿的直接胆红素及谷氨酸氨基转移酶峰值均低于MCT/LCT组（P < 0.05）。结论 ELBW儿应用SMOF没有降低相关并发症的发生率；但和应用MCT/LCT比较，SMOF能减轻ELBW儿发生PNAC的严重程度。

Abstract

Objective To study the clinical effect of multi-oil fat emulsion for parenteral nutrition support in extremely low birth weight (ELBW) infants. Methods A retrospective analysis was performed for 49 ELBW infants who were admitted from January 1, 2018 to July 30, 2020, with an age of ≤14 days on admission and a duration of parenteral nutrition of > 14 days. According to the type of lipid emulsion received, the ELBW infants were divided into two groups: soybean oil, medium-chain triglycerides, olive oil, and fish oil (SMOF) (n=26) and medium-chain triglycerides/long-chain triglycerides (MCT/LCT) (n=23). The two groups were compared in terms of clinical features, complications, nutrition support therapy, and outcome. Results The 49 ELBW infants had a mean birth weight of (892±83) g and a mean gestational age of (28.2±2.3) weeks. There was no significant difference between the two groups in the incidence rates of hemodynamically significant patent ductus arteriosus, intraventricular hemorrhage, neonatal necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia (BPD), grade Ⅲ BPD, sepsis, and pneumonia (P > 0.05). There was also no significant difference in the duration of parenteral nutrition, the age of total enteral nutrition, and head circumference/body length/body weight at discharge between the two groups (P > 0.05). Of all the infants, 22 (45%) had parenteral nutrition-associated cholestasis (PNAC), with 13 (50%) in the SMOF group and 9 (39%) in the MCT/LCT group but there was no significant difference in the incidence of PNAC between the two groups (P > 0.05); however, the infants with PNAC in the SMOF group had significantly lower peak values of direct bilirubin and alanine aminotransferase than those in the MCT/LCT group (P < 0.05). Conclusions The application of multi-oil fat emulsion in ELBW infants does not reduce the incidence rate of complications, but compared with MCT/LCT emulsion, SMOF can reduce the severity of PNAC in ELBW infants.

导出引用

林慧佳, 沈晓霞, 倪映华, 马晓路, 施丽萍, 杜立中. 多种油脂肪乳在超低出生体重儿中应用的疗效分析[J]. 中国当代儿科杂志. 2021, 23(3): 229-235 https://doi.org/10.7499/j.issn.1008-8830.2011029

LIN Hui-Jia, SHEN Xiao-Xia, NI Ying-Hua, MA Xiao-Lu, SHI Li-Ping, DU Li-Zhong. Clinical effect of multi-oil fat emulsion for parenteral nutrition support in extremely low birth weight infants[J]. Chinese Journal of Contemporary Pediatrics. 2021, 23(3): 229-235 https://doi.org/10.7499/j.issn.1008-8830.2011029

参考文献

[1] Fallon EM, Le HD, Puder M. Prevention of parenteral nutrition-associated liver disease:role of omega-3 fish oil[J]. Curr Opin Organ Transplant, 2010, 15(3):334-340.
[2] Calder PC, Jensen GL, Koletzko BV, et al. Lipid emulsions in parenteral nutrition of intensive care patients:current thinking and future directions[J]. Intensive Care Med, 2010, 36(5):735-749.
[3] 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 4版. 北京:人民卫生出版社, 2011.
[4] Shepherd JL, Noori S. What is a hemodynamically significant PDA in preterm infants?[J]. Congenit Heart Dis, 2019, 14(1):21-26.
[5] Jain A, Shah PS. Diagnosis, evaluation, and management of patent ductus arteriosus in preterm neonates[J]. JAMA Pediatr, 2015, 169(9):863-872.
[6] Higgins RD, Jobe AH, Koso-Thomas M, et al. Broncho-pulmonary dysplasia:executive summary of a workshop[J]. J Pediatr, 2018, 197:300-308.
[7] Lauriti G, Zani A, Aufieri R, et al. Incidence, prevention, and treatment of parenteral nutrition-associated cholestasis and intestinal failure-associated liver disease in infants and children:a systematic review[J]. JPEN J Parenter Enteral Nutr, 2014, 38(1):70-85.
[8] 王陈红, 施丽萍, 吴秀静, 等. 早产儿胃肠外营养相关性胆汁淤积症的临床特征[J]. 中华儿科杂志, 2011, 49(3):199-202.
[9] 潘敦, 陈辉, 李良庆. 多种油脂肪乳在胃肠外科重症患者术后肠外营养中的应用[J]. 南方医科大学学报, 2015, 35(9):1312-1315.
[10] de Meijer VE, Gura KM, Le HD, et al. Fish oil-based lipid emulsions prevent and reverse parenteral nutrition-associated liver disease:the Boston experience[J]. JPEN J Parenter Enteral Nutr, 2009, 33(5):541-547.
[11] Kelly DA. Preventing parenteral nutrition liver disease[J]. Early Hum Dev, 2010, 86(11):683-687.
[12] Ng K, Stoll B, Chacko S, et al. Vitamin E in new-generation lipid emulsions protects against parenteral nutrition-associated liver disease in parenteral nutrition-fed preterm pigs[J]. JPEN J Parenter Enteral Nutr, 2016, 40(5):656-671.
[13] Gura KM, Lee S, Valim C, et al. Safety and efficacy of a fish-oil-based fat emulsion in the treatment of parenteral nutrition-associated liver disease[J]. Pediatrics, 2008, 121(3):e678-e686.
[14] Torgalkar R, Dave S, Shah J, et al. Multi-component lipid emulsion vs soy-based lipid emulsion for very low birth weight preterm neonates:a pre-post comparative study[J]. J Perinatol, 2019, 39(8):1118-1124.
[15] Skouroliakou M, Konstantinou D, Agakidis C, et al. Cholestasis, bronchopulmonary dysplasia, and lipid profile in preterm infants receiving MCT/ω-3-PUFA-containing or soybean-based lipid emulsions[J]. Nutr Clin Pract, 2012, 27(6):817-824.
[16] Repa A, Binder C, Thanhaeuser M, et al. A mixed lipid emulsion for prevention of parenteral nutrition associated cholestasis in extremely low birth weight infants:a randomized clinical trial[J]. J Pediatr, 2018, 194:87-93.e1.
[17] Kapoor V, Malviya MN, Soll R. Lipid emulsions for parenterally fed preterm infants[J]. Cochrane Database Syst Rev, 2019, 6(6):CD013163.
[18] Lee HH, Jung JM, Nam SH, et al. Risk factor analysis of parenteral nutrition-associated cholestasis in extremely low birth weight infants[J]. Acta Paediatr, 2016, 105(7):e313-e319.
[19] Hwang JH, Chung ML. Predictive value of the aspartate aminotransferase to platelet ratio index for parenteral nutrition associated cholestasis in extremely low birth weight infants[J]. BMC Pediatr, 2019, 19(1):126.
[20] Kasirer Y, Bin-Nun A, Raveh A, et al. SMOFlipid protects preterm neonates against perinatal nutrition-associated cholestasis[J]. Am J Perinatol, 2019, 36(13):1382-1386.
[21] Lin HJ, Du LZ, Ma XL, et al. Mortality and morbidity of extremely low birth weight infants in the mainland of China:a multi-center study[J]. Chin Med J (Engl), 2015, 128(20):2743-2750.
[22] Smith LE. Through the eyes of a child:understanding retinopathy through ROP the Friedenwald lecture[J]. Invest Ophthalmol Vis Sci, 2008, 49(12):5177-5182.
[23] Beken S, Dilli D, Fettah ND, et al. The influence of fish-oil lipid emulsions on retinopathy of prematurity in very low birth weight infants:a randomized controlled trial[J]. Early Hum Dev, 2014, 90(1):27-31.
[24] Pawlik D, Lauterbach R, Walczak M, et al. Fish-oil fat emulsion supplementation reduces the risk of retinopathy in very low birth weight infants:a prospective, randomized study[J]. JPEN J Parenter Enteral Nutr, 2014, 38(6):711-716.
[25] Thébaud B, Goss KN, Laughon M, et al. Bronchopulmonary dysplasia[J]. Nat Rev Dis Primers, 2019, 5(1):78.
[26] Hwang JS, Rehan VK. Recent advances in bronchopulmonary dysplasia:pathophysiology, prevention, and treatment[J]. Lung, 2018, 196(2):129-138.