Effect Of Early Total Parenteral Nutrition On The Premature Infants Outcome

Objective:To explore effect of Early Total Parenteral Nutrition on the Premature Infants Outcome.Methods:By adoptting prospective study,100 perterm infants admitted to the second affiliated hospital of kunming medical university NICU from May 2014 to January 2015 were collected.The hospitalized perterm infants in the same period were divided into 2 groups, which included 51 cases in observation group and 49 cases in control group.Observation group was that total parenteral nutrition was used in 24 hours. Control group was that total parenteral nutrition was used in 72 hours.Observation group:6.7% pediatric compound amino acid and 20% medium and long chain fat emulsion were given within 24 hours after born; amino acid and fat emulsion were started with 1.0g/kg.d, and increased gradually by 1.0g/kg.d,10% glucose was started form 4-8mg/kg-min.Amino acids increased to 3.0g/kg.d and fat emulsion increased to 3.0g/kg.d at the 3th day. Multi-trace elements injection(addamel),water-vitamin for injection(soluvit) and fatsoluble vitamin injection(Ⅱ)(vitalipid) were given with 1.0mL/kg-d.Control group:It was only that 10% glucose was given in 24 hours after born,6.7% pediatric compound amino acid was given in 48 hours after born and 20% medium and long chain fat emulsion was given in 72 hours after born.Amino acid were started with 1.0g/kg.d.Fat emulsion was started with 0.5～1g/kg.d. Amino acid and lipid emulsion were gradually inceased by 0.5g/kg.d.Amino acid was inceased to 3.0g/kg.d at the 6th-7th day. Lipid emulsion was inceased to 3.0g/kg.d at the 6th-7th day.Multi-trace elements injection(addamel), water-vitamin for injection(soluvit) and fatsoluble vitamin injection(Ⅱ)(vitalipid) were given with1.0mL/kg·d.Two groups of children were observed to the growth and development index about weight, length,head circumference,the hospital stay,the complication of intravenous feeding,hospital infection rate and mortality rate,and soResults:1.The gestational age,gender,birth weight,length and head circumference, there was no statistically significant difference in two groups of premature infants ,P>0.05.2.Between observation group and the control group,the difference of weight gain,body length gain,head circumference gain,the percentage of physiological weight loss, the number of days to regain birth weigh and the hospital stay were statistically significant during the application of intravenous feeding.3.During the application of intravenous feeding,the observation group with 51 cases of premature infants,PNAC occurred in 2 cases (3.9%); high blood triglycerides occurred in 2 cases(3.9%); nitrogen mass occurred in 3 cases (5.9%);hypoglycemia occurred in 11 cases(21.6%); hyperglycemia occurred in 7 cases (13.7%);hypokalemia occurred in 9 cases (17.6%); hypocalcemia occurred in 14 cases (27.5%).The control group with 49 cases of premature infants,PNAC occurred in 6 cases (12.2%);high blood triglycerides occurred in 1 cases (2.0%);nitrogen mass occurred in 2 cases (4.1%) and hypogly--cemia occurred in 10 cases (20.4%);hyperglycemia occurred in 6 cases (12.2%); hypokalemia occurred in 8 cases (16.3%);hypocalcemia occurred in 13 cases (26.5%). Between observation group and control group, the difference of high blood trigly--cerides, nitrogen mass, hypoglycemia,hyperglycemia,hypokalemia and hypoca--lcemia the hospital stay were not statistically significant,p>0.05.But observation group was significantly lower than the control group on the incident of PNAC.The difference was significant,p<0.05.4.In 100 cases of premature infants,28 cases happened nosocomial infection and hospital infection rate was 28%.51 cases of premature infants in observation group,9 cases happened nosocomial infection and the infection rate was 17.6%; 49 cases of premature infants in control group,19 cases occured nosocomial infection, and the infection rate was 38.8%.Observation group compared with control group, the low incidence of infection, the difference was statistically significant(x2= 4.535, P< 0.05).5.In 100 cases of premature infants,8 cases happened hospital death and hospital death rate was 8%.51 cases of premature infants in observation group,5 cases happened death and the mortality rate was 9.8%; 49 cases of premature infants in control group,3 cases occured death and themortality rate was 6.1%.Observation group compared with control group, the difference was not significant (x2= 0.095, P> 0.05).Conclusions:1.Early positive total parenteral nutrition can obviously improve constitution of premature infants, improve the growth of weight,length and head circumference, lower the physiological weight loss,reduce the number of days to regain birth weigh and the hospital stay and also reduce the incidence of EUGR.2.Early positive total parenteral nutrition can reduce the incidence of PNAC,and did not lead to the other parenteral nutrition related complications.3.Early positive total parenteral nutrition can reduce the incidence of premature infant hospital infection.4.Early positive total parenteral nutrition has no influence on premature mortality.