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Abstract：
BACKGROUND: The persistence of high serum osmolality in the early postnatal period is a risk for developing patent ductus arteriosus (PDA). Early aggressive nutrition (EAN), involving total parenteral nutrition (TPN), by which enough concentrations of glucose and amino acids are administered intravenously, is recommended postnatally to improve the neurological prognosis in preterm infants. However, the effects of EAN involving TPN on serum osmolality and the development of a PDA have not been adequately studied.
OBJECTIVE: Thus, in this study, we aimed to investigate the impact of TPN on serum osmolality and determine whether increased serum osmolality could be associated with a higher incidence of PDA in preterm infants.
METHODS: In this single-center retrospective observational study, preterm infants born at <28 weeks of gestation who had been admitted to our neonatal intensive care unit (NICU) before (pre-TPN period) and after the introduction of TPN (post-TPN) were included. We reviewed the medical records of these patients, compared the changes in serum osmolality from birth to five days after birth, the clinical background, and the incidence of PDA between these two periods, and analyzed the risk factors. Additionally, the factors affecting the serum osmolality in very preterm infants were examined. The patients who met the intervention criteria of our NICU and received a cyclooxygenase (COX) inhibitor, Indacin® (Nobelpharma, Tokyo, Japan), within seven days after birth were classified as PDA+; those who could not be identified to have PDA flow by echo and did not receive a COX inhibitor were classified as PDA-.
RESULTS: The postnatal day and serum sodium (Na+) were statistically significantly correlated with a higher serum osmolality. Serum osmolality remained statistically significantly higher in the PDA+ cohort compared with the PDA- cohort after the first day of life. However, no statistically significant differences were observed in serum osmolality after 24 hours of age, weeks of gestational age, birth weight, or incidence of PDA between the pre- and post-TPN periods. The results of the multiple logistic regression analyses revealed that the increased serum osmolality correlated with PDA development.
CONCLUSIONS: In this study, the serum Na+ statistically significantly correlated with a higher serum osmolality. Moreover, the increased serum osmolality correlated with PDA development. Thus, the prevention of hypernatremia might reduce the incidence of PDA. Nonetheless, the findings in this study revealed that no statistically significant differences in serum osmolality were observed between the pre-and post-TPN periods, indicating that TPN had little effect on serum osmolality.
OBJECTIVE: Thus, in this study, we aimed to investigate the impact of TPN on serum osmolality and determine whether increased serum osmolality could be associated with a higher incidence of PDA in preterm infants.
METHODS: In this single-center retrospective observational study, preterm infants born at <28 weeks of gestation who had been admitted to our neonatal intensive care unit (NICU) before (pre-TPN period) and after the introduction of TPN (post-TPN) were included. We reviewed the medical records of these patients, compared the changes in serum osmolality from birth to five days after birth, the clinical background, and the incidence of PDA between these two periods, and analyzed the risk factors. Additionally, the factors affecting the serum osmolality in very preterm infants were examined. The patients who met the intervention criteria of our NICU and received a cyclooxygenase (COX) inhibitor, Indacin® (Nobelpharma, Tokyo, Japan), within seven days after birth were classified as PDA+; those who could not be identified to have PDA flow by echo and did not receive a COX inhibitor were classified as PDA-.
RESULTS: The postnatal day and serum sodium (Na+) were statistically significantly correlated with a higher serum osmolality. Serum osmolality remained statistically significantly higher in the PDA+ cohort compared with the PDA- cohort after the first day of life. However, no statistically significant differences were observed in serum osmolality after 24 hours of age, weeks of gestational age, birth weight, or incidence of PDA between the pre- and post-TPN periods. The results of the multiple logistic regression analyses revealed that the increased serum osmolality correlated with PDA development.
CONCLUSIONS: In this study, the serum Na+ statistically significantly correlated with a higher serum osmolality. Moreover, the increased serum osmolality correlated with PDA development. Thus, the prevention of hypernatremia might reduce the incidence of PDA. Nonetheless, the findings in this study revealed that no statistically significant differences in serum osmolality were observed between the pre-and post-TPN periods, indicating that TPN had little effect on serum osmolality.
摘要：
背景：出生后早期高血清渗透压的持续存在是发生动脉导管未闭（PDA）的风险。早期积极营养（EAN），涉及全胃肠外营养（TPN），通过静脉内给予足够浓度的葡萄糖和氨基酸，建议产后改善早产儿的神经系统预后。然而,涉及TPN的EAN对血清渗透压和PDA发展的影响尚未得到充分研究。
目标：因此，在这项研究中，我们的目的是研究TPN对血清渗透压的影响,并确定血清渗透压升高是否与早产儿PDA发病率升高相关.
方法：在这项单中心回顾性观察研究中，包括在妊娠<28周时出生的早产儿,他们在引入TPN之前(TPN前)和之后(TPN后)入住我们的新生儿重症监护病房(NICU).我们查看了这些病人的医疗记录,比较了从出生到出生后五天血清渗透压的变化，临床背景，以及这两个时期之间PDA的发生率，并分析了风险因素。此外,研究了影响极早产儿血清渗透压的因素。符合我们NICU干预标准并接受环氧合酶（COX）抑制剂的患者，Indacin®(Nobelpharma，东京,Japan),出生后7天内的患者被分类为PDA+;那些无法通过回声确定有PDA血流且未接受COX抑制剂的患者被分类为PDA-.
结果：出生后天数和血清钠（Na+）与较高的血清渗透压有统计学显著相关。在生命的第一天之后,与PDA-队列相比,PDA+队列中的血清渗透压在统计学上保持显著较高。然而,年龄24小时后的血清渗透压无统计学差异，孕周，出生体重,或TPN前后PDA的发生率。多元逻辑回归分析的结果表明，血清渗透压增加与PDA的发展有关。
结论：在这项研究中，血清Na+与较高的血清渗透压在统计学上显著相关。此外，血清渗透压增加与PDA发育相关。因此，预防高钠血症可能降低PDA的发生率.尽管如此，这项研究的结果表明，在TPN前和后期间，没有观察到血清渗透压的统计学差异，说明TPN对血清渗透压影响不大。
目标：因此，在这项研究中，我们的目的是研究TPN对血清渗透压的影响,并确定血清渗透压升高是否与早产儿PDA发病率升高相关.
方法：在这项单中心回顾性观察研究中，包括在妊娠<28周时出生的早产儿,他们在引入TPN之前(TPN前)和之后(TPN后)入住我们的新生儿重症监护病房(NICU).我们查看了这些病人的医疗记录,比较了从出生到出生后五天血清渗透压的变化，临床背景，以及这两个时期之间PDA的发生率，并分析了风险因素。此外,研究了影响极早产儿血清渗透压的因素。符合我们NICU干预标准并接受环氧合酶（COX）抑制剂的患者，Indacin®(Nobelpharma，东京,Japan),出生后7天内的患者被分类为PDA+;那些无法通过回声确定有PDA血流且未接受COX抑制剂的患者被分类为PDA-.
结果：出生后天数和血清钠（Na+）与较高的血清渗透压有统计学显著相关。在生命的第一天之后,与PDA-队列相比,PDA+队列中的血清渗透压在统计学上保持显著较高。然而,年龄24小时后的血清渗透压无统计学差异，孕周，出生体重,或TPN前后PDA的发生率。多元逻辑回归分析的结果表明，血清渗透压增加与PDA的发展有关。
结论：在这项研究中，血清Na+与较高的血清渗透压在统计学上显著相关。此外，血清渗透压增加与PDA发育相关。因此，预防高钠血症可能降低PDA的发生率.尽管如此，这项研究的结果表明，在TPN前和后期间，没有观察到血清渗透压的统计学差异，说明TPN对血清渗透压影响不大。
