早期肠外营养与早产儿支气管肺发育不良发生的关系

doi:10.7499/j.issn.1008-8830.2210128

摘要
图/表
参考文献(28)
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (538 KB) [HTML]
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的分析生后1周未能肠内营养的胎龄<32周早产儿肠外营养素摄入情况与支气管肺发育不良（bronchopulmonary dysplasia，BPD）发生的关系。方法回顾性收集2017年10月—2022年8月出生并于生后24 h内转入苏州大学附属儿童医院新生儿重症监护病房、胎龄<32周、生后第1周营养摄入完全依靠肠外营养的早产儿作为研究对象，包括79例BPD患儿和73例非BPD患儿。比较两组早产儿住院期间的临床资料。结果 BPD组生后体重下降超过10%、宫外生长发育迟缓、胃肠外营养相关性胆汁淤积的患儿比例较非BPD组高（P<0.05），出生体重恢复时间、达完全肠内营养时间、出院时纠正胎龄均大于非BPD组（P<0.05），而纠正胎龄36周时体格发育Z评分低于非BPD组（P<0.05）。BPD组生后1周内液体摄入量高于非BPD组（P<0.05），而热卡摄入量低于非BPD组（P<0.05）；BPD组生后1周内氨基酸、葡萄糖、脂质的起始剂量及其摄入总量均低于非BPD组（P<0.05）；BPD组生后第3天的糖脂比高于非BPD组，生后第7天的热氮比和糖脂比均高于非BPD组（P<0.05）。结论 BPD患儿生后1周内氨基酸和脂质的摄入量及其所提供的热卡占总热量的比例低于非BPD患儿，提示早期肠外营养素摄入与BPD的发生可能有关。［中国当代儿科杂志，2023，25（4）：362-367］

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	徐儒政
	孙斌
	赵乃琤

关键词 ：支气管肺发育不良, 早期营养, 肠外营养, 早产儿

Abstract：Objective To study the relationship between early parenteral nutrient intake and the development of bronchopulmonary dysplasia (BPD) in preterm infants with gestational age less than 32 weeks who could not receive enteral nutrition within one week after birth. Methods A retrospective study was conducted on preterm infants born between October 2017 and August 2022 with gestational age less than 32 weeks who were admitted to the Neonatal Intensive Care Unit in Children's Hospital of Soochow University within 24 hours after birth and relied solely on parenteral nutrition within the first week of life. The study population included 79 infants with BPD and 73 infants without BPD. Clinical data during hospitalization were compared between the two groups. Results The proportions of infants with weight loss of more than 10% after birth, extrauterine growth retardation, and parenteral nutrition-associated cholestasis in the BPD group were higher than in the non-BPD group (P<0.05). The time to regain birth weight, time to achieve full enteral feeding, and corrected gestational age at discharge were longer in the BPD group than in the non-BPD group. The Z-scores of physical growth at corrected gestational age of 36 weeks were lower in the BPD group than in the non-BPD group (P<0.05). The BPD group had a higher fluid intake and a lower calories intake in the first week than the non-BPD group (P<0.05). The starting dose and total amount of amino acids, glucose, and lipids in the first week were lower in the BPD group than in the non-BPD group (P<0.05). The BPD group had a higher glucose-to-lipid ratio on the third day and higher energy-to-nitrogen and glucose-to-lipid ratios on the seventh day after birth than the non-BPD group (P<0.05). Conclusions Preterm infants with BPD had lower intake of amino acids and lipids and a lower proportion of calories provided by amino acids and lipids in the first week of life, which suggests an association between early parenteral nutrition intake and the development of BPD. Citation:Chinese Journal of Contemporary Pediatrics, 2023, 25(4): 362-367

Key words： Bronchopulmonary dysplasia Early nutrition Parenteral nutrition Preterm infant

收稿日期: 2022-10-27

通讯作者: 赵乃琤，女，主任医师。Email：zhaonz2003@163.com。 E-mail: zhaonz2003@163.com

作者简介: 徐儒政，男，硕士，住院医师；

引用本文:

徐儒政,孙斌,赵乃琤. 早期肠外营养与早产儿支气管肺发育不良发生的关系[J]. 中国当代儿科杂志, 2023, 25(4): 362-367.

XU Ru-Zheng,SUN Bin,ZHAO Nai-Cheng. Association between early parenteral nutrition and the development of bronchopulmonary dysplasia in preterm infants[J]. CJCP, 2023, 25(4): 362-367.

链接本文:

http://www.zgddek.com/CN/10.7499/j.issn.1008-8830.2210128 或 http://www.zgddek.com/CN/Y2023/V25/I4/362

	McCarthy M. Outcomes in extremely preterm US infants improve, study finds[J]. BMJ, 2015, 351: h4851. PMID: 26353773. DOI: 10.1136/bmj.h4851.
	Cao Y, Jiang S, Sun J, et al. Assessment of neonatal intensive care unit practices, morbidity, and mortality among very preterm infants in China[J]. JAMA Netw Open, 2021, 4(8): e2118904. PMID: 34338792. PMCID: PMC8329742. DOI: 10.1001/jamanetworkopen.2021.18904.
	Higgins RD, Jobe AH, Koso-Thomas M, et al. Bronchopulmonary dysplasia: executive summary of a workshop[J]. J Pediatr, 2018, 197: 300-308. PMID: 29551318. PMCID: PMC5970962. DOI: 10.1016/j.jpeds.2018.01.043.
	Xu Y, Yu Z, Li Q, et al. Dose-dependent effect of human milk on bronchopulmonary dysplasia in very low birth weight infants[J]. BMC Pediatr, 2020, 20(1): 522. PMID: 33190629. PMCID: PMC7666971. DOI: 10.1186/s12887-020-02394-1.
	5 曹献云, 李岩, 剧松丽, 等. 高剂量氨基酸和脂肪乳肠外营养对合并感染的早产患儿营养状况的影响研究[J]. 中华医院感染学杂志, 2017, 27(5): 1159-1162. DOI: 10.11816/cn.ni.2016-163103.
	6 林佳佳, 刘素佳, 欧阳夏, 等. 超低出生体质量儿应用多种油脂肪乳与中长链脂肪乳的效果[J]. 中国卫生标准管理, 2021, 12(18): 96-99. DOI: 10.3969/j.issn.1674-9316.2021.18.033.
	Friedman Z, Danon A, Stahlman MT, et al. Rapid onset of essential fatty acid deficiency in the newborn[J]. Pediatrics, 1976, 58(5): 640-649. PMID: 824608.
	Higgins RD, Jobe AH, Koso-Thomas M, et al. Bronchopulmonary dysplasia: executive summary of a workshop[J]. J Pediatr, 2018, 197:300-308.PMID: 29551318. PMCID: PMC5970962. DOI: 10.1016/j.jpeds.2018.01.043.
	Principi N, Di Pietro GM, Esposito S. Bronchopulmonary dysplasia: clinical aspects and preventive and therapeutic strategies[J]. J Transl Med, 2018, 16(1): 36. PMID: 29463286. PMCID: PMC5819643. DOI: 10.1186/s12967-018-1417-7.
	Shin SH, Shin SH, Kim SH, et al. The association of pregnancy-induced hypertension with bronchopulmonary dysplasia: a retrospective study based on the Korean neonatal network database[J]. Sci Rep, 2020, 10(1): 5600. PMID: 32221404. PMCID: PMC7101434. DOI: 10.1038/s41598-020-62595-7.
	Dell'Orto V, Raschetti R, Centorrino R, et al. Short- and long-term respiratory outcomes in neonates with ventilator-associated pneumonia[J]. Pediatr Pulmonol, 2019, 54(12): 1982-1988. PMID: 31456358. DOI: 10.1002/ppul.24487.
	Londhe VA, Maisonet TM, Lopez B, et al. Retinoic acid rescues alveolar hypoplasia in the calorie-restricted developing rat lung[J]. Am J Respir Cell Mol Biol, 2013, 48(2): 179-187. PMID: 23087051. PMCID: PMC3604067. DOI: 10.1165/rcmb.2012-0229OC.
	Xu XF, Lv Y, Gu WZ, et al. Epigenetics of hypoxic pulmonary arterial hypertension following intrauterine growth retardation rat: epigenetics in PAH following IUGR[J]. Respir Res, 2013, 14(1): 20. PMID: 23406533. PMCID: PMC3577465. DOI: 10.1186/1465-9921-14-20.
	14 杨俏文. 200例早产儿支气管肺发育不良的临床研究[J]. 中国妇幼保健, 2016, 31(8): 1662-1664. DOI: 10.7620/zgfybj.j.issn.1001-4411.2016.08.34.
	Maayan-Metzger A, Mazkereth R, Kuint J. Weight loss and bronchopulmonary dysplasia in very low birth weight infants[J]. Fetal Pediatr Pathol, 2008, 27(4/5): 215-222. PMID: 18800264. DOI: 10.1080/15513810802319533.
	Oh W, Poindexter BB, Perritt R, et al. Association between fluid intake and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants[J]. J Pediatr, 2005, 147(6): 786-790. PMID: 16356432. DOI: 10.1016/j.jpeds.2005.06.039.
	17 侯阿娜, 张妮, 富建华, 等. 支气管肺发育不良早产儿早期肺外合并症的临床分析[J]. 中国小儿急救医学, 2017, 24(4): 273-277. DOI: 10.3760/cma.j.issn.1673-4912.2017.04.008.
	Parikh NA, Kennedy KA, Lasky RE, et al. Pilot randomized trial of hydrocortisone in ventilator-dependent extremely preterm infants: effects on regional brain volumes[J]. J Pediatr, 2013, 162(4): 685-690.e1. PMID: 23140612. PMCID: PMC3609889. DOI: 10.1016/j.jpeds.2012.09.054.
	Parikh NA, Kennedy KA, Lasky RE, et al. Neurodevelopmental outcomes of extremely preterm infants randomized to stress dose hydrocortisone[J]. PLoS One, 2015, 10(9): e0137051. PMID: 26376074. PMCID: PMC4573756. DOI: 10.1371/journal.pone.0137051.
	20 许世敏, 李向红, 徐佳鑫, 等. 早期营养对早产儿支气管肺发育不良的影响[J]. 中华临床营养杂志, 2021, 29(3): 148-156. DOI: 10.3760/cma.j.cn115822-20210222-00040.
	Wemh?ner A, Ortner D, Tschirch E, et al. Nutrition of preterm infants in relation to bronchopulmonary dysplasia[J]. BMC Pulm Med, 2011, 11: 7. PMID: 21291563. PMCID: PMC3040142. DOI: 10.1186/1471-2466-11-7.
	22 孙秀英. 早期非营养性吸吮及发展性照顾对早产儿胃肠功能及体重增长的影响[J]. 中国现代医生, 2018, 56(27): 48-51.
	Klevebro S, Westin V, Stoltz Sj?str?m E, et al. Early energy and protein intakes and associations with growth, BPD, and ROP in extremely preterm infants[J]. Clin Nutr, 2019, 38(3): 1289-1295. PMID: 29885776. DOI: 10.1016/j.clnu.2018.05.012.
	Tenorio-Lopes L, Baldy C, Jochmans-Lemoine A, et al. Consequences of maternal omega-3 polyunsaturated fatty acid supplementation on respiratory function in rat pups[J]. J Physiol, 2017, 595(5): 1637-1655. PMID: 27861919. PMCID: PMC6426158. DOI: 10.1113/JP273471.
	Uberos J, Jimenez-Montilla S, Molina-Oya M, et al. Early energy restriction in premature infants and bronchopulmonary dysplasia: a cohort study[J]. Br J Nutr, 2020, 123(9): 1024-1031. PMID: 31964427. DOI: 10.1017/S0007114520000240.
	Vlaardingerbroek H, Schierbeek H, Rook D, et al. Albumin synthesis in very low birth weight infants is enhanced by early parenteral lipid and high-dose amino acid administration[J]. Clin Nutr, 2016, 35(2): 344-350. PMID: 26028361. DOI: 10.1016/j.clnu.2015.04.019.
	Leenders EKSM, de Waard M, van Goudoever JB. Low- versus high-dose and early versus late parenteral amino-acid administration in very-low-birth-weight infants: a systematic review and meta-analysis[J]. Neonatology, 2018, 113(3): 187-205. PMID: 29268262. DOI: 10.1159/000481192.
	欧洲儿科胃肠肝病与营养学会, 欧洲临床营养与代谢学会, 欧洲儿科研究学会, 等. 儿科肠外营养指南(2016版)推荐意见节译[J]. 中华儿科杂志, 2018, 56(12): 885-896. PMID: 30518002. DOI: 10.3760/cma.j.issn.0578-1310.2018.12.003.