Study on intravenous amino acid administration to late preterm infants directly after birth

Abstract

Abstract: 【Objective】 To test the hypothesis that the early administration of amino acids (AA) 2.4 g/(kg·d) to late preterm infants is safe and resultful in a positive nitrogen balance. 【Methods】 A randomized and clinical trial was conducted. Preterm infants with gestational ages between 34W to 36⁺⁶W received either glucose and AA 2.4 g/(kg·d) from birth onward (within 2 hours after birth) (n=56) or solely glucose during the first day with a stepwise increase in AA intake to AA 2.4 g/(kg·d) on days 3 (n=59). Blood gas analysis was performed at admission and in the 2^nd, 4^th postnatal days; blood urea nitrogen levels were determined on the 2^nd day and the 4^thday after birth; nitrogen balances were determined on the 2^nd day and the 4^thday after birth. 【Results】 Modestly altered blood gas values (BE and Bicarbonate) and increased BUN levels with early AA administration in intervention group compared with those in control group (P<0.05 or <0.01 respectively). The infants in the control group had higher glucose level than those in the intervention group at the second day after birth (P<0.05). Nitrogen balance was higher in the intervention group on the 2^nd day after birth as compared with the control group, which had a negative nitrogen balance (P<0.05). 【Conclusions】 High-dose AA administration to late preterm infants can be introduced safely from birth onward and resultful in an anabolic state.

Key words: late-preterm infants, high-dose amino acid administration, early

摘要： 【目的】评价晚期早产儿(34 ~36⁺⁶周)中,在生后2 h内给予静脉补充氨基酸的效果和安全性。【方法】将115例患儿随机分为两组,治疗组在生后2 h内给予静脉输注氨基酸[2.4 g/(kg·d)],对照组则在生后第1天仅给予输注葡萄糖治疗,在第3天逐渐增加到氨基酸2.4 g/(kg·d)。并动态测定患儿的血气、血糖、BUN及氮平衡情况。【结果】治疗组患儿的BE和HCO^{₃在生后的第2、4天均低于对照组(P<0.05或0.01)。生后第2天血糖监测显示对照组较治疗组偏高(P<0.05)。治疗组生后第2、4天的血尿素氮水平明显高于对照组(P<0.01)。生后第2天,治疗组的氮平衡明显高于对照组(P<0.05),并且对照组呈负氮平衡。【结论】对晚期早产儿早期补充高剂量氨基酸是安全的,使机体处于合成代谢状态,为生长发育所必需。}

关键词: 晚期早产儿, 大剂量氨基酸, 早期

CLC Number:

R722.6

KONG Xiang-yong, LIU Jing, KONG Ling-kai, ZHOU Wei-qin, ZHENG Yang, CHI Jing-han, LI Li-hua, SHANG Ming-xia, FENG Zhi-chun. Study on intravenous amino acid administration to late preterm infants directly after birth[J]. journal1, 2011, 19(9): 786-788.

孔祥永,刘敬,孔令凯,周伟勤,郑杨,池婧涵,李丽华,商明霞,封志纯. 晚期早产儿早期静脉补充氨基酸治疗的临床研究[J]. 中国儿童保健杂志, 2011, 19(9): 786-788.

References

[1] Thureen PJ, Hay WW. Intravenous nutrition and postnatal growth of the micropremie[J]. Clin Perinatol,2000,27(1):197-219.
[2] Thureen PJ, Melara D, Fennessey PV, et al. Effect of low versus high intravenous amino acid intake on very low birth weight infants in the early neonatal period[J]. Pediatr Res,2003,53(1):24-32. [3] Te Braake FW, van den Akker CH, Riedijk MA, et al. Parenteral amino acid and energy administration to premature infants in early life[J]. Semin Fetal Neonatal Med,2007,12(1):11-18.
[4] Te Braake FW, van den Akker CH, Wattimena DJ, et al. Amino acid administration to premature infants directly after birth[J]. J Pediatr,2005,147(4):457-461.
[5] 易乐春,雷志松,朱明勇,等.早产儿非脂肪乳静脉营养治疗的临床观察[J].中国儿童保健杂志,2007,15(3):307-308.
[6] Geary C, Caskey M, Fonseca R, et al. Decreased incidence of bronchopulmonary dysplasia after early management changes, including surfactant and nasal continuous positive airway pressure treatment at delivery, lowered oxygen saturation goals, and early amino acid administration: a historical cohort study[J]. Pediatrics,2008,121(1):89-96.
[7] Denne SC, Poindexter BB. Evidence supporting early nutritional support with parenteral amino acid infusion[J]. Semin Perinatol,2007,31(2):56-60.
[8] Zello GA, Menendez CE, Rafii M, et al. Minimum protein intake for the preterm neonate determined by protein and amino acid kinetics[J]. Pediatr Res,2003,53(2):338-344.
[9] Mrozek JD, Georgieff MK, Blazar BR, et al. Effect of sepsis syndrome on neonatal protein and energy metabolism[J]. J Perinatol,2000,20(2):96-100.
[10] 姚裕家,母得志,杨凡.早产儿营养基础与实践指南[M].2版.北京:人民卫生出版社,2008:50-55.
[11] Poindexter BB, Karn CA, Leitch CA, et al. Amino acids do not suppress proteolysis in premature neonates[J]. Am J Physiol Endocrinol Metab,2001,281(3):472-478.
[12] Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants-2010 update[J]. Neonatology,2010,97(4):402-417.
[13] 白雪梅,刘正娟,李述君,等.早产儿低出生体重儿两种静脉营养方式的对比研究[J].中国当代儿科杂志, 2005,7(4):325-328.
[14] Van Veen LC, Teng C, Hay WW, et al. Leucine disposal and oxidation rates in the fetal lamb[J]. Metabolism,1987,36(1):48-53.
[15] Hay WW, Thureen PJ. Early postnatal administration of intravenous amino acids to preterm, extremely low birth weight infants[J]. J Pediatr,2006,148(3):291-294.