Clinical Research Of Infusing Different Doses Of Fat Emulsions In Premature Infants

Objectives⊿Survival of premature infant is inseparable from the good and effective nutrition, parenteral nutrition (parenteral nutrition, PN) play an important role in improving the survival rate of critically ill infant. Preterm infant have tolerance of all or part of the PN (TPN or PPN) in 1～2d after birth. Application of PN in premature infant usually put lipid as the main energy material, give premature especially extremely low birth weight infant (ELBWI) lipid can prevent essential fatty acids (EFA) deficiency. Because fat emulsions also can aggravate jaundice, cause cholestasis and hyperlipidemia, etc, it's dose and potential adverse reaction is controversial. Previous research shows it is safe that input fat emulsion at a uniform speed from a dose of 0.5 g/(kg·d), increase gradually to 3.0～3.5 g/(kg·d), do not lead to metabolic acidosis, hyperlipidemia, do not affect pulmonary function and not increase the incidence of infections. But the optimal fat intake amount formed for body organization constitute remains unclear. This research, through case-control study, using different initial doses and speed of increasing amounts, to evaluate differences between different application ways of fat emulsion in early parenteral nutrition, discusses the more effective application ways.Methods:60 premature infants, which were admitted within 24h after birth,30～34 weeks gestational age,1200～2000g birth weight, exclude pregnancy complication of the mother, congenital malformations, congenital metabolic diseases, history of fetal distress, birth asphyxia and cardiopulmonary disease. Liver function, sugar and fat metabolism were normal, were randomly divided into 2 groups. The observation group receiving fat emulsion 24h after birth, the initial dose is 1.0 g/kg, increase 1.0 g/(kg·d), till the sufficient dose, while the control group's initial dose is 0.5 g/kg, increase 0.5 g/(kg·d), till the sufficient dose. Amino acid's target dose of two groups were 3 g/(kg·d), fat emulsion's target dose of two groups were 3.0 g/(kg·d). The two groups were established peripheral intravenous catheter infusion channel after be admitted, based on the conventional therapy of preterm children, infuse glucose firstly, and add amino acids in within 24 hours, add 20% lipid emulsion after 24 hours. Intaking amount of total fluid volume, glucose, amino acids was same between two groups every day. The fat emulsion mixed with other nutrient solution, controlled by microinfusion pump, infused at a uniform speed within 24 hours. Observe time of restoring to birth weight, average time of parenteral nutrition, time of hyperbilirubinemia occurs and duration of the jaundice, detect the platelet count, blood glucose level, arterial blood gas,the blood levels of cholesterol and triglyceride and the serum biochemical indexes relative to liver functions, chest x-ray film. Then analyze the results. Determination of blood lipids include total cholesterol (TC), triacylglycerol (TG); liver function include total bile acid (TBA), total bilirubin (TB), alanine aminotranaferase (ALT),γ-glutamyl transferase (GGT).Results:1.The time of restoring to birth weight and average total parenteral nutrition in obse--rvation group were 4.47±0.86,6.9±1.647, while the control group were 6.63±1.129,8.83±2.437, showed significant difference.2. There were no significant differences in time of hyperbilirubinemia occurs and jaundice continuous between two groups, and planet count, blood glucose level, arterial blood gas,the blood levels of cholesterol and triglyceride and the serum biochemical indexes relative to liver functions, chest x-ray film did not change remarkably in two groups.3. It did not show extrauterine growth restriction (EUGR) and parenteral nutrition related complicationsConclusions:1. Applying the initial amount 1 g/kg, increasing 1 g/(kg·d), until 3 g/(kg·d), infusing 24 hours after birth, it is safe in clinical.2. Although hyperbilirubinemia may be present, Serum bilirubin can be reducedrapidly and the time of jaundice doesn't last long when we take measures in time. 3. It doesn't influence respiratory ventilation and air exchange function, and does't cause the complications such as thrombocytopenia, hyperlipidemia and intrahepatic cholestasis.4. It causes transient increase of the value of r-Glutamyltransferase, and the value can be normal when PN is over.5. Compared with the method that we apply PN with starting dose of 0.5g/(kg·d) and increase the dose by0.5g/(kg·d), the time spent in regaining the birth weight and the PN is recuced.