| Objectives: Preterm infants especially very low birth-weight infants (VLBWI) and extremely low birth-weight infants (ELBWI) often need parenteral nutrition because of their lack of intrauterine deposition of nutrients (both carbohydrates and fats), immature gastroenteral function and the diseases related to premature birth. Nutrition is very important to the preterm infants because the nutritional state had influences on weight gain, the morbidity of complications, mortality and the long term developmental outcome of the preterm infants. Early and aggressive use of amino acids and fat emulsion could provide adequate essential nutrients such as nitrogen and energy and maintain nutritional integrity of the body, promote weight gain, decrease growth problems, lessen complications, shorten hospital stay. Fat emulsion could prevent the lack of long-chain polyunsaturated fatty acids such as docosahexaenoic acid(DHA) and arachidonic acid(AA) so as to decrease the damage of the brain and other organs and improve the living quality of the preterm infants.This study aimed to investigate the intolerance and short term clinical outcomes in preterm infants receiving an aggressive regimen of parenteral nutrition. Metheds: Total of 86 preterm infants were assigned into two groups randomly. Forty five were in aggressive group, mean birth weight was 1290+215g, gestational age was 30.2+1.2w. Amino acid solution and fat emulsion were started beginning on the first day of life. Amino acids were l.Og/kg.d, increased by l.Og/kg.d up to a maximum of 3.0g/kg.d. Lipids were l.Og/kg.d, increased by l.Og/kg.d up to a maximum of 3.0-4.Og/kg.d. Forty one were in control group, mean birth weight was 1310+235g,gestational age was 30.4+1.6w. Amino acid solution was started on the third day of life. Amino acids were started with 0.5g/kg.d, increased by 0.5g/kg.d up to a maximum of 3.0g/kg.d. Lipids were started beginning on the forth day of life with 0.5g/kg.d, increased by 0.5g/kg.d up to a maximum of 3.0g/kg.d. Nutritional solution was "all in one" including glucose, amino acids, lipids vitamins and trace elements. Parenteral nutrition was administrated through peripheral veins in 24 hours a day. Statistical analysis was done using Student's t test or X2 test. Result: 1.There were no differences of the concentrations of triglyceride (TG), bilirubin(Bil), blood urea nitrogen(BUN) and base excess(BE) between two groups. No hyperbilirubinemia, liver or kidney damages occurred in both groups. 2. Compared to control group, preterm infants receiving an aggressive regimen had a more rapid weight gain(32.0?.5g/d vs 21.8+7.8g/d, p<0.01), shorter parenteral nutrition time(9.5+3.6 vs 13.4+4.2 days, p<0.01), shorter hospital stay (19.2+10.5 vs 25.8+11.3 days, p<0.01) and fewer complications (26.67% vs 48.78%, p<0.05) . 3. There was no difference of mortality between two groups. Conclusion: Preterm infants could receive an early and aggressive parenteral nutrition regimen without apparent side effects. Compared to control group, early and aggressive parenteral nutrition could improve the weight gain, shorten parenteral nutrition time, shorten hospital stay, and decrease complications of preterm infants.Chenkai (Pediatrics) Directed by Litang... |
