Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
권호 표지

Early Effective Parenteral Nutrition for Preterm Infants

미숙아의 효과적인 조기 정맥영양

  • Lee, Byong-Sop (Division of Neonatology, Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center)
  • 이병섭 (울산대학교 의과대학 소아과학교실)
  • Published : 2009.11.30

⟨ Previous Next ⟩

Abstract

Mimicking fetal nutrition is the goal of early paretneral nutrition (PN) in very low birth weight infants, however the limited metabolic capacity of immature organs raises concern about the toxicity of metabolites to the developing brain. Starting parenteral amino acids from the first day of life, with a rate of 1.0 to 1.5 g/kg/day, is generally recommended to prevent endogenous protein breakdown by maintaining a positive nitrogen balance. A greater of amino acid infusion rate in the range of the fetal transfer rate (3.5-4.0 g/kg/day) is well tolerated during the early days after birth in VLBWI, however the influence on growth and long-term neurodevelopmental outcome remains unknown. Limited data are available from controlled trials regarding the effects of early supplementation with lipid emulsions on neonatal morbidity. Considering the role of long-chain polyunsaturated fatty acids in the neurodevelopment, the choice of an optimal lipid emulsion should be based on the quality as well as the quantity of the lipid contents. Little is known about the clinical benefit of higher rates of glucose infusion by permitting high serum glucose level or co-administration with insulin.

Keywords

References

  1. Lemons JA, Bauer CR, Oh W, Korones SB, Papile LA, Stoll BJ, et al. Very low birth weight outcomes of the National Institute of Child health and human development neonatal research network, January 1995 through December 1996. NICHD Neonatal Research Network. Pediatrics 2001;107:E1. https://doi.org/10.1542/peds.107.1.e1
  2. McClellan R, Novak D. Fetal nutrition: how we become what we are. J Pediatr Gastroenterol Nutr 2001;33:233-44. https://doi.org/10.1097/00005176-200109000-00002
  3. Hanebutt FL, Demmelmair H, Schiessl B, Larque E, Koletzko B. Long-chain polyunsaturated fatty acid (LC-PUFA) transfer across the placenta. Clin Nutr 2008;27:685-93. https://doi.org/10.1016/j.clnu.2008.05.010
  4. Herrera E, Amusquivar E, Lopez-Soldado I, Ortega H. Maternal lipid metabolism and placental lipid transfer. Horm Res 2006;65 Suppl 3:59-64. https://doi.org/10.1159/000091507
  5. Gudinchet F, Schutz Y, Micheli JL, Stettler E, Jequier E. Metabolic cost of growth in very low-birth-weight infants. Pediatr Res 1982;16:1025-30. https://doi.org/10.1203/00006450-198212000-00012
  6. Uthaya S, Thomas E, Hamilton G, Dore C, Bell J, Modi N. Altered adiposity after extremely preterm birth. Pediatr Res 2005;57:211-5. https://doi.org/10.1203/01.PDR.0000148284.58934.1C
  7. Singhal A, Cole T, Lucas A. Early nutrition in preterm infants and later blood pressure: two cohorts after randomised trials. Lancet 2001;357:413-9. https://doi.org/10.1016/S0140-6736(00)04004-6
  8. Singhal A, Cole TJ, Fewtrell M, Deanfield J, Lucas A. Is slower early growth beneficial for long-term cardiovascular health? Circulation 2004;109:1108-13. https://doi.org/10.1161/01.CIR.0000118500.23649.DF
  9. Singhal A, Fewtrell M, Cole T, Lucas A. Low nutrient intake and early growth for later insulin resistance in adolescents born preterm. Lancet 2003;361:1089-97. https://doi.org/10.1016/S0140-6736(03)12895-4
  10. Kalhan S, Edmison J. Effect of intravenous amino acids on protein kinetics in preterm infants. Curr Opin Clin Nutr Metab Care 2007;10:69-74. https://doi.org/10.1097/MCO.0b013e328011924d
  11. Bohe J, Low JF, Wolfe RR, Rennie MJ. Latency and duration of stimulation of human muscle protein synthesis during continuous infusion of amino acids. J Physiol 2001;532:575-9. https://doi.org/10.1111/j.1469-7793.2001.0575f.x
  12. Darmaun. Noninvasive techniques to monitor nutrition in neonates. In: RA P, editor. Neonatology Questions and Controversies. 1st ed. Philadelphia: Saunders, Elsevier; 2008.
  13. Denne SC, Karn CA, Wang J, Liechty EA. Effect of intravenous glucose and lipid on proteolysis and glucose production in normal newborns. Am J Physiol 1995;269:E361-7.
  14. Fukagawa NK, Minaker KL, Rowe JW, Goodman MN, Matthews DE, Bier DM, et al. Insulin-mediated reduction of whole body protein breakdown. Dose-response effects on leucine metabolism in postabsorptive men. J Clin Invest 1985;76:2306-11. https://doi.org/10.1172/JCI112240
  15. Poindexter BB, Karn CA, Ahlrichs JA, Wang J, Leitch CA, Liechty EA, et al. Amino acids suppress proteolysis independent of insulin throughout the neonatal period. Am J Physiol 1997;272:E592-9.
  16. Tessari P, Inchiostro S, Biolo G, Trevisan R, Fantin G, Marescotti MC, et al. Differential effects of hyperinsulinemia and hyperaminoacidemia on leucine-carbon metabolism in vivo. Evidence for distinct mechanisms in regulation of net amino acid deposition. J Clin Invest 1987;79:1062-9. https://doi.org/10.1172/JCI112919
  17. Kadrofske MM, Parimi PS, Gruca LL, Kalhan SC. Effect of intravenous amino acids on glutamine and protein kinetics in low-birth-weight preterm infants during the immediate neonatal period. Am J Physiol Endocrinol Metab 2006;290:E622-30. https://doi.org/10.1152/ajpendo.00274.2005
  18. te Braake FW, van den Akker CH, Riedijk MA, van Goudoever JB. Parenteral amino acid and energy administration to premature infants in early life. Semin Fetal Neonatal Med 2007;12:11-8. https://doi.org/10.1016/j.siny.2006.10.002
  19. Embleton ND. Optimal protein and energy intakes in preterm infants. Early Hum Dev 2007;83:831-7. https://doi.org/10.1016/j.earlhumdev.2007.10.001
  20. Adamkin DH. Nutrition Management of the Very Low-birthweight Infant: I. Total Parenteral Nutrition and Minimal Enteral Nutrition. Neoreviews 2006;7:e602-7. https://doi.org/10.1542/neo.7-12-e602
  21. Koletzko B, Goulet O, Hunt J, Krohn K, Shamir R. 1. Guidelines on Paediatric Parenteral Nutrition of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the European Society for Clinical Nutrition and Metabolism (ESPEN), Supported by the European Society of Paediatric Research (ESPR). J Pediatr Gastroenterol Nutr 2005:41 Suppl 2:S1-87.
  22. Mrozek JD, Georgieff MK, Blazar BR, Mammel MC, Schwarzenberg SJ. Effect of sepsis syndrome on neonatal protein and energy metabolism. J Perinatol 2000;20:96-100. https://doi.org/10.1038/sj.jp.7200319
  23. Zlotkin SH, Bryan MH, Anderson GH. Intravenous nitrogen and energy intakes required to duplicate in utero nitrogen accretion in prematurely born human infants. J Pediatr 1981;99:115-20. https://doi.org/10.1016/S0022-3476(81)80975-4
  24. Kashyap S, Schulze KF, Forsyth M, Zucker C, Dell RB, Ramakrishnan R, et al. Growth, nutrient retention, and metabolic response in low birth weight infants fed varying intakes of protein and energy. J Pediatr 1988;113:713-21. https://doi.org/10.1016/S0022-3476(88)80388-3
  25. Saenz de Pipaon M, Quero J, Wattimena DJ, Sauer PJ. Effect of two amino acid solutions on leucine turnover in preterm infants. BioI Neonate 2005;87:236-41. https://doi.org/10.1159/000083389
  26. Wilson DC, Cairns P, Halliday HL, Reid M, McClure G, Dodge JA. Randomised controlled trial of an aggressive nutritional regimen in sick very low birth-weight infants. Arch Dis Child Fetal Neonatal Ed 1997;77:F4-11. https://doi.org/10.1136/fn.77.1.F4
  27. Thureen PJ, Melara D, Fennessey PV, Hay WW Jr. Effect of low versus high intravenous amino acid intake on very low birth weight infants in the early neonatal period. Pediatr Res 2003;53:24-32. https://doi.org/10.1203/00006450-200301000-00008
  28. te Braake FW, van den Akker CH, Wattimena DJ, Huijmans JG, van Goudoever JB. Amino acid administration to premature infants directly after birth. J Pediatr 2005;147:457-61. https://doi.org/10.1016/j.jpeds.2005.05.038
  29. Poindexter BB, Langer JC, Dusick AM, Ehrenkranz RA. Early provision of parenteral amino acids in extremely low birth weight infants: relation to growth and neurodevelopmental outcome. J Pediatr 2006;148:300-5. https://doi.org/10.1016/j.jpeds.2005.10.038
  30. Clark RH, Chace DH, Spitzer AR. Effects of two different doses of amino acid supplementation on growth and blood amino acid levels in premature neonates admitted to the neonatal intensive care unit: a randomized, controlled trial. Pediatrics 2007;120:1286-96. https://doi.org/10.1542/peds.2007-0545
  31. Maggio L, Cota F, Gallini F, Lauriola V, Zecca C, Romagnoli C. Effects of high versus standard early protein intake on growth of extremely low birth weight infants. J Pediatr Gastroenterol Nutr 2007; 44:124-9. https://doi.org/10.1097/01.mpg.0000237927.00105.f7
  32. Stephens BE, Walden RV, Gargus RA, Tucker R, McKinley L, Mance M, et al. First-week protein and energy intakes are associated with 18-month developmental outcomes in extremely low birth weight infants. Pediatrics 2009;123:1337-43. https://doi.org/10.1542/peds.2008-0211
  33. Dinerstein A, Nieto RM, Solana CL, Perez GP, Otheguy LE, Larguia AM. Early and aggressive nutritional strategy (parenteral and enteral) decreases postnatal growth failure in very low birth weight infants. J Perinatol 2006;26:436-42. https://doi.org/10.1038/sj.jp.7211539
  34. Ibrahim HM, Jeroudi MA, Baier RJ, Dhanireddy R, Krouskop RW. Aggressive early total parental nutrition in low-birth-weight infants. J Perinatol 2004;24:482-6. https://doi.org/10.1038/sj.jp.7211114
  35. Kotsopoulos K, Benadiba-Torch A, Cuddy A, Shah PS. Safety and efficacy of early amino acids in preterm &It;28 weeks gestation: prospective observational comparison. J Perinatol 2006;26:749-54. https://doi.org/10.1038/sj.jp.7211611
  36. Blanco CL, Falck A, Green BK, Cornell JE, Gong AK. Metabolic responses to early and high protein supplementation in a randomized trial evaluating the prevention of hyperkalemia in extremely low birth weight infants. J Pediatr 2008;153:535-40. https://doi.org/10.1016/j.jpeds.2008.04.059
  37. Clandinin MT, Van Aerde JE, Merkel KL, Harris CL, Springer MA, Hansen JW, et al. Growth and development of preterm infants fed infant formulas containing docosahexaenoic acid and arachidonic acid. J Pediatr 2005;146:461-8. https://doi.org/10.1016/j.jpeds.2004.11.030
  38. Clandinin MT, Chappell JE, Heim T, Swyer PR, Chance GW. Fatty acid utilization in perinatal de novo synthesis of tissues. Early Hum Dev 1981;5:355-66. https://doi.org/10.1016/0378-3782(81)90016-5
  39. Lehner F, Demmelmair H, Roschinger W, Decsi T, Szasz M, Adamovich K, et al. Metabolic effects of intravenous LCT or MCT/LCT lipid emulsions in preterm infants. J Lipid Res 2006:47:404-11. https://doi.org/10.1194/jlr.M500423-JLR200
  40. Driscoll DF, Bistrian BR, Demmelmair H, Koletzko B. Pharmaceutical and clinical aspects of parenteral lipid emulsions in neonatology. Clin Nutr 2008;27:497-503. https://doi.org/10.1016/j.clnu.2008.05.003
  41. Deckelbaum RJ. Intravenous lipid emulsions in pediatrics: time for a change? J Pediatr Castroennterol Nutr 2003;37:112-4. https://doi.org/10.1097/00005176-200308000-00004
  42. Gura KM, Lee S, Valim C, Zhou J, Kim S, Modi BP, et al. Safety and efficacy of a fish-oil-based fat emulsion in the treatment of parenteral nutrition-associated liver disease. Pediatrics 2008;121:e678-86.
  43. Sosenko IR, Innis SM, Frank L. Polyunsaturated fatty acids and protection of newborn rats from oxygen toxicity. J Pediatr 1988;112:630-7. https://doi.org/10.1016/S0022-3476(88)80186-0
  44. Sosenko IR, Rodriguez-Pierce M, Bancalari E. Effect of early initiation of intravenous lipid administration on the incidence and severity of chronic lung disease in premature infants. J Pediatr 1993; 123:975-82. https://doi.org/10.1016/S0022-3476(05)80397-X
  45. Simmer K, Rao SC. Early introduction of lipids to parenterally-fed preterm infants. Cochrane Database Syst Rev 2005;2:CD005256.
  46. Kairamkonda VR, Khashu M. Controversies in the management of hyperglycemia in the ELBW infant. Indian Pediatr 2008:45:29-38.
  47. Van den Berghe G, Wilmer A, Hermans G, Meers-seman W, Wouters PJ, Milants I, et al. Intensive insulin therapy in the medical ICU. N Engl J Med 2006;354:449-61. https://doi.org/10.1056/NEJMoa052521
  48. Klein GW, Hojsak JM, Schmeidler J, Rapaport R. Hyperglycemia and outcome in the pediatric intensive care unit. J Pediatr 2008;153:379-84. https://doi.org/10.1016/j.jpeds.2008.04.012
  49. Arabi YM, Dabbagh OC, Tamim HM, Al-Shimemeri AA, Memish ZA, Haddad SH, et al. Intensive versus conventional insulin therapy: a randomized controlled trial in medical and surgical critically ill patients. Crit Care Med 2008;36:3190-7. https://doi.org/10.1097/CCM.0b013e31818f21aa
  50. Hays SP, Smith EO, Sunehag AL. Hyperglycemia is a risk factor for early death and morbidity in extremely low birth-weight infants. Pediatrics 2006;118:1811-8. https://doi.org/10.1542/peds.2006-0628
  51. Meetze W, Bowsher R, Compton J, Moorehead H. Hyperglycemia in extremely- low-birth-weight infants. BioI Neonate 1998;74:214-21. https://doi.org/10.1159/000014027
  52. Collins JW Jr, Hoppe M, Brown K, Edidin DV, Padbury J, Ogata ES. A controlled trial of insulin infusion and parenteral nutrition in extremely low birth weight infants with glucose intolerance. J Pediatr 1991;118:921-7. https://doi.org/10.1016/S0022-3476(05)82212-7
  53. Beardsall K, Ogilvy-Stuart AL, Frystyk J, Chen JW, Thompson M, Ahluwalia J, et al. Early elective insulin therapy can reduce hyperglycemia and increase insulin-like growth factor-I levels in very low birth weight infants. J Pediatr 2007;151:611-7, 7.el. https://doi.org/10.1016/j.jpeds.2007.04.068
  54. Beardsall K, Vanhaesebrouck S, Ogilvy-Stuart AL, Vanhole C, Palmer CR, van Weissenbruch M, et al. Early insulin therapy in very-low-birth-weight infants. N Engl J Med 2008;359:1873-84. https://doi.org/10.1056/NEJMoa0803725