The Research Of The Stability Of Total Nutrient Admixture With Iron And The Safety And Efficacy Of It To Prevent Preterm Infants From Anemia

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The Research of the Stability of Total Nutrient Admixture with Iron Sucrose and Fat ParticlesObjective:Evaluate the stability of iron-containing total nutrient admixture(TNA)and fat particles to supply theoretical evidence for new method of supplement iron by parenteral nutrition clinically.Methods : Design six concentration gradients of iron sucrose(0,0.2,0.4,0.6,0.8,1.0mg/100ml)which was added in different electrolyte combination of divalent cations(calcium ion,magnesium ion)to detect the changes of PN in aspect,p H,osmotic pressure,mean droplet diameter(MDD),percent fat exceeding 5?m(Pfat5),free fatty acid(FFA)and anisidine value in 0h,24 h,48h after preparation.Results:1.There were no changes of 18 groups TNA which were hang at room temperature in color,delamination or sediment in 0h,24 h,48h after preparation.2.The p H was 5.50-5.93,osmotic pressure was 840-947 m Osm/kg,MDD was 187-199 nm,Pfat5 was 0.0048-0.0384%,FFA was 0.06-0.56mmol/L,AV was 0.51-1.55 in 48 h after preparation.3.There were no significant difference in different groups of no calcium and magnesium,having calcium but no magnesium and having magnesium but no calcium(P>0.05).Conclusion:Total nutrient admixtures which were contained iron sucrose of 0-1.0mg/100 m L concentration and fat particles were stable in 48 h after preparation at room temperature.Part ? Efficacy and safety of parenteral nutrition with iron sucrose to prevent preterm infants from anemia — randomized,double-blind controlled studyObjective: To study the efficacy and safety of PN which is added in iron sucrose for prevention of anemia in preterm infants.To supply evidences for prevention of anemia in preterm infants by parenteral nutrition support route.Methods: A randomized,double-blind controlled trial.Low birth weight and preterm infants(gestational age<37 weeks,1500±50g?BW?2000g±50g)who were born in Xin Hua Hospital,School of Medicine,Shanghai Jiao Tong University and admitted to Neonatal Intensive Care Unit were recruited,and duration of parenteral nutrition(PN)was more than 7 days.The recruited infants were divided into five groups randomly: control group Iron-0(PN without iron sucrose),intervension group Iron-1(PN with iron sucrose 100?g/kg/d),Iron-2(PN with iron sucrose 200?g/kg/d),Iron-3(PN with iron sucrose 300?g/kg/d),Iron-4(PN with iron sucrose 400?g/kg/d).Baseline values for all parameters(sex,birth weight,gestational age,the duration of PN,the number of blood drawing from capillary or vein)were recorded.Collect the indexes of red blood cell parameters(red blood cell,hemoglobin and hematocrit),iron storage(serum ferritin,serum iron)and oxidant injury(malondialdehyde)before and after PN with different dosage of iron sucrose(time error was ± 2 days).Results: 1.Eleminate 6 preterm infants who accepted transfusion,one infant who was dead because of pneumorrhagia 6 days after birth,and 22 infants whose information was not complete(the test indexes were not complete before or after PN surpport),in the end,there are 100 preterm infants included in this study.Iron-0 group was 20 infants,Iron-1 group was 17 infants,Iron-2 group was 21 infants,Iron-3 group was 23 infants and Iron-4 group was 19 infants.There were no significant statistical differences in birth weight,gestation,the time of PN,time of blood drawing from capillary or vein among five groups.2.After infusing PN contained different dosages iron sucrose,HCT in Iron-1 group was significantly higher than control group(41.0% vs 36.7%,P=0.027),RBC,HB and HCT in other groups was higher than control group but there was no significant statistical differences(P>0.05).Serum ferritin(SF)in Iron-4 group was significantly higher than control group(388.5 ng/ml vs 155.0 ng/ml,P=0.017),and in other groups was higher than control group but there was no significant statistical differences(P >0.05).Serum iron(SI)in Iron-3 group was significantly higher than control group(16.4?mol/L vs 12.4?mol/L,P=0.029),except for Iron-1 groups,SI in other groups was higher than control group but there was no significant statistical differences(P>0.05).MDA in Iron-1 group was significantly higher than control group(16.2nmol/ml vs 11.5nmol/ml,P=0.025),and in other groups was higher than control group but there was no significant statistical differences(P>0.05).3.The decrease range of RBC(-0.6×10-2/L vs-0.9×10-2/L,P=0.034)and HB(-26 g/L vs-41 g/L,P=0.03)in Iron-1 group,HCT(-9.5% vs-14.0%,P=0.015)in Iron-2 group was significantly lower than control group,except for RBC in Iron-2 group,erythrocyte parameters in interfered group was decreased more than control group but there was no significant statistical differences(P>0.05).The rising range of SF in Iron-4 group was significantly higher than control group(197.8 ng/ml vs 52.0 ng/ml,P=0.004),and other interfered groups were higher than control group but there was no significant statistical differences(P>0.05).And the rising range of SF was increased with the increased dosage of iron sucrose.The rising range of SI in Iron-3 group was significantly higher than control group(12.2?mol/L vs 6.6?mol/L,P=0.016),and other interfered groups were higher than control group but there was no significant statistical differences(P>0.05).The rising range of MDA in four interfered groups was higher than control group but there was also no significant statistical differences(P>0.05).Conclusion: 1.Parenteral nutrition which is added in iron sucrose with 100?g/kg/d to 400?g/kg/d is applied by preterm infants safely.2.Compared to PN without iron sucrose,to some extent,PN support with iron sucrose can improve erythrocyte parameters and increase iron storage and SI concentration,and plays a role in preventing from anemia for preterm infants.But the optimal dosage of iron sucrose still needs clinical study of a larger sample acquired.