早期肠外营养与早产儿支气管肺发育不良发生的关系

Association between early parenteral nutrition and the development of bronchopulmonary dysplasia in preterm infants

摘要:

目的 分析生后1周未能肠内营养的胎龄<32周早产儿肠外营养素摄入情况与支气管肺发育不良（bronchopulmonary dysplasia，BPD）发生的关系。方法 回顾性收集2017年10月—2022年8月出生并于生后24 h内转入苏州大学附属儿童医院新生儿重症监护病房、胎龄<32周、生后第1周营养摄入完全依靠肠外营养的早产儿作为研究对象，包括79例BPD患儿和73例非BPD患儿。比较两组早产儿住院期间的临床资料。结果 BPD组生后体重下降超过10%、宫外生长发育迟缓、胃肠外营养相关性胆汁淤积的患儿比例较非BPD组高（P<0.05），出生体重恢复时间、达完全肠内营养时间、出院时纠正胎龄均大于非BPD组（P<0.05），而纠正胎龄36周时体格发育Z评分低于非BPD组（P<0.05）。BPD组生后1周内液体摄入量高于非BPD组（P<0.05），而热卡摄入量低于非BPD组（P<0.05）；BPD组生后1周内氨基酸、葡萄糖、脂质的起始剂量及其摄入总量均低于非BPD组（P<0.05）；BPD组生后第3天的糖脂比高于非BPD组，生后第7天的热氮比和糖脂比均高于非BPD组（P<0.05）。结论 BPD患儿生后1周内氨基酸和脂质的摄入量及其所提供的热卡占总热量的比例低于非BPD患儿，提示早期肠外营养素摄入与BPD的发生可能有关。

Abstract:

Objective To study the relationship between early parenteral nutrient intake and the development of bronchopulmonary dysplasia (BPD) in preterm infants with gestational age less than 32 weeks who could not receive enteral nutrition within one week after birth.Methods A retrospective study was conducted on preterm infants born between October 2017 and August 2022 with gestational age less than 32 weeks who were admitted to the Neonatal Intensive Care Unit in Children's Hospital of Soochow University within 24 hours after birth and relied solely on parenteral nutrition within the first week of life. The study population included 79 infants with BPD and 73 infants without BPD. Clinical data during hospitalization were compared between the two groups.Results The proportions of infants with weight loss of more than 10% after birth, extrauterine growth retardation, and parenteral nutrition-associated cholestasis in the BPD group were higher than in the non-BPD group (P<0.05). The time to regain birth weight, time to achieve full enteral feeding, and corrected gestational age at discharge were longer in the BPD group than in the non-BPD group. The Z-scores of physical growth at corrected gestational age of 36 weeks were lower in the BPD group than in the non-BPD group (P<0.05). The BPD group had a higher fluid intake and a lower calories intake in the first week than the non-BPD group (P<0.05). The starting dose and total amount of amino acids, glucose, and lipids in the first week were lower in the BPD group than in the non-BPD group (P<0.05). The BPD group had a higher glucose-to-lipid ratio on the third day and higher energy-to-nitrogen and glucose-to-lipid ratios on the seventh day after birth than the non-BPD group (P<0.05).Conclusions Preterm infants with BPD had lower intake of amino acids and lipids and a lower proportion of calories provided by amino acids and lipids in the first week of life, which suggests an association between early parenteral nutrition intake and the development of BPD.