PDF(Pubmed)
Abstract：
Parenteral nutrition (PN) is a standard of care for preterm infants in the first postnatal days. The European Society of Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) has updated their guideline recommendations on PN in 2018. However, data on actual 2018 guideline adherence in clinical practice are sparse. In this retrospective study, conducted at the neonatal intensive care unit (NICU) of Ghent University Hospital, we analyzed the ESPGHAN 2018 PN guideline adherence and growth for 86 neonates admitted to the NICU. Analyses were stratified by birth weight (<1000 g, 1000 to <1500 g, ≥1500 g). We documented the provisions for enteral nutrition (EN) and PN, and we tested the combined EN and PN provisions for ESPGHAN 2018 adherence. The nutrition protocols showed a high adherence to PN guidelines in terms of carbohydrate provisions, yet lipid provisions for EN and PN often exceeded the recommended maximum of 4 g/kg/d; although, PN lipid intakes maxed out at 3.6 g/kg/d. Protein provisions tended to fall below the recommended minimum of 2.5 g/kg/d for preterm infants and 1.5 g/kg/d for term neonates. The energy provisions also tended to fall below the minimum recommendations, especially for neonates with a birth weight (BW) < 1000 g. Over a mean PN duration of 17.1 ± 11.4 d, the median weekly Fenton Z-scores changes for length, weight, and head circumference were positive for all BW groups. Future studies have to assess how protocols adapt to current guidelines, and how this affects short- and long-term growth across different BW groups. In conclusion, the reported findings provide real-world evidence regarding the effect of ESPGHAN 2018 PN guideline adherence, and they demonstrate how standardized neonatal PN solutions can safeguard stable growth during NICU stays.
摘要：
肠胃外营养（PN）是早产儿出生后第一天的护理标准。欧洲儿科胃肠病学会，肝病学,和营养（ESPGHAN）在2018年更新了他们关于PN的指南建议。然而,2018年临床实践指南依从性的实际数据很少.在这项回顾性研究中,在根特大学医院的新生儿重症监护病房（NICU）进行，我们分析了ESPGHAN2018PN指南中纳入NICU的86例新生儿的依从性和生长情况.分析按出生体重分层(<1000克，1000至<1500g，≥1500g)。我们记录了肠内营养(EN)和PN的规定，我们测试了ESPGHAN2018的EN和PN合并条款。营养方案在碳水化合物供应方面高度遵守PN指南，然而，EN和PN的脂质供应经常超过建议的最大值4g/kg/d；尽管，PN脂质摄入量最高为3.6g/kg/d。早产儿的蛋白质供应倾向于低于建议的最小值2.5g/kg/d，足月新生儿的建议最小值1.5g/kg/d。能源供应也往往低于最低建议，特别是对于出生体重（BW）<1000g的新生儿。平均PN持续时间为17.1±11.4d，每周FentonZ分数中位数随长度而变化，体重,所有BW组的头围均为阳性。未来的研究必须评估协议如何适应当前的指南，以及这如何影响不同BW组的短期和长期增长。总之,报告的发现提供了关于ESPGHAN2018PN指南依从性效果的现实证据，他们展示了标准化的新生儿PN解决方案如何在NICU住院期间确保稳定的生长。
